MedicaidPrior AuthHigh impact
20-522 California's Children's Services, SAR Forms and Claims Billing Guidelines
Health Net·CA · Pediatrics·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net has updated guidelines for California Children's Services (CCS) prior authorization requirements and claims billing procedures. All CCS-eligible services must receive prior authorization using specific SAR forms, and providers must refer potentially eligible children within 24 hours or face denials with authorization only retroactive to the referral date.
Action Required
Immediately: Billing team must ensure all CCS-eligible services receive prior authorization before treatment using correct SAR forms (New Referral, Discharge Planning, or Established Client). Providers must refer potentially eligible children to CCS within 24 hours of identification or admission. Update billing workflows to submit claims to CCS fiscal intermediary only after confirming member eligibility, CCS program enrollment, and SAR issuance. Claims without proper authorization will be denied.