MedicaidPrior AuthHigh impact
21-470 Prior Authorization Changes for California Children’s Services
Health Net·CA · Cardiology, Dermatology, Endocrinology +10 more·Prior Authorization
Effective date
Dec 17, 2024
We identified it
Jun 20, 2026
Summary
Effective immediately for California Children's Services (CCS) in Fresno, Kings, and Madera counties: office visits for pediatric subspecialists no longer require prior authorization, but in-office procedures by 13 specified subspecialties (including cardiologists, orthopedists, neurologists, etc.) now require prior authorization. All CCS referrals must be submitted within 24 hours with complete documentation.
Action Required
Immediately: Update billing system to remove prior authorization requirements for pediatric subspecialist office visits but ADD prior authorization requirements for in-office procedures performed by cardiologists, dermatologists, endocrinologists, gastroenterologists, geneticists, nephrologists, neurologists, ophthalmologists, orthopedists, ENTs, podiatrists, pulmonologists, and urologists. Train staff on 24-hour referral submission deadlines for CCS-eligible conditions and ensure all Service Authorization Request (SAR) forms include complete medical documentation. Update encounter forms to reflect new prior auth requirements for subspecialty procedures.