MedicaidPrior AuthMedium impact
20-668 Learn When to Coordinate Care with California Children's Services
Health Net·CA · Pediatrics, Family Medicine, Emergency Medicine +1 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
This policy clarifies coordination of care responsibilities between providers and California Children's Services (CCS) for Medi-Cal members in Fresno, Kings, and Madera counties. Once CCS eligibility is established, CCS assumes case management and prior authorization for all services related to the CCS-eligible condition, and care must be provided by CCS-paneled providers at CCS-approved facilities.
Action Required
Immediately: Billing team must identify Medi-Cal patients in Fresno, Kings, and Madera counties who may be CCS-eligible. Update workflows to coordinate with CCS program for prior authorization of services related to CCS conditions. For emergency inpatient admissions at non-CCS facilities, refer to county CCS program by next business day and arrange transfer to CCS-approved facility once stabilized. Contact CalViva Health at 1-888-893-1569 for CCS training and assistance with Service Authorization Requests.