MedicaidCoverageHigh impact
08-10-2026 Pediatric specialty care referrals in San Diego County SD
Molina Healthcare·CA · Pediatrics·Provider Bulletin
Effective date
Aug 10, 2026
We identified it
Aug 15, 2026
Summary
Effective immediately, all Molina Healthcare Medi-Cal pediatric members under age 18 in San Diego County requiring specialty care must be referred to Rady Children's Specialists of San Diego (RCSSD). Referrals outside RCSSD will not be reimbursed except in rare circumstances with prior authorization. ABA/BHT services and DME/orthotics must be referred to separate networks (Molina's ABA/BHT network and Verio Healthcare Inc., respectively).
Action Required
Immediately: (1) Billing team must update EMR/billing system to route all Molina San Diego County Medi-Cal referrals for members under 18 to Rady Children's Specialists of San Diego (RCSSD) only. (2) Update all referral templates and encounter forms to reflect mandatory RCSSD referral requirement. (3) Front desk and clinical staff must verify patient age and Molina San Diego County Medi-Cal eligibility before processing specialty referrals. (4) For ABA/BHT services: route to Molina's dedicated ABA/BHT network, not RCSSD. (5) For DME/orthotics: route to Verio Healthcare Inc., not RCSSD. (6) Obtain prior authorization from RCSSD Utilization Management Operations (877-276-4543) for all specialty services. (7) Screen for California Children's Services (CCS) eligibility and refer eligible members to CCS program instead of RCSSD. Failure to comply will result in claim denials for out-of-network referrals and reimbursement denial.