MedicaidPrior AuthMedium impact
20-523 California Children's Services, SAR Forms and Claims Billing Guidelines
Health Net·CA · Pediatrics·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net updated guidelines for California Children's Services (CCS) requiring providers in Fresno, Kings, and Madera counties to refer potentially eligible children within 24 hours and use specific Service Authorization Request (SAR) forms for prior authorization of CCS-related services.
Action Required
Immediately: Providers must refer potentially eligible children to CCS within 24 hours using appropriate SAR forms (New Referral, Established Client, or Discharge Planning forms). Submit supporting documentation within 24 hours of initial notification. Billing team must ensure SAR authorization is obtained before submitting claims for CCS-eligible conditions and use correct provider numbers (NPI, not CGP numbers) on claims.