26-1064 Refer Eligible Members to CCS and Use CCS-Paneled Providers

IMMEDIATELY: Billing team and clinical staff must implement the following: (1) Update intake and eligibility workflows to screen all Medi-Cal members under age 21 for CCS-eligible conditions; (2) When CCS eligibility is identified, verify member's CCS enrollment status and refer to local CCS county office if not enrolled (use New CCS/GHPP Client SAR form) or submit Established CCS/GHPP Client SAR form if already enrolled; (3) Before rendering services for CCS-eligible conditions, verify in the CCS-paneled provider list that the treating provider is paneled with CCS—do NOT proceed with services by non-paneled providers except in limited emergency situations; (4) Update billing system and encounter forms with CCS verification checkpoints; (5) Train all clinical and front-desk staff on CCS referral requirements and SAR submission processes. CONSEQUENCES: Claims for CCS-eligible condition services will be denied, Health Net will not cover charges, and the provider will be held financially responsible for all related services and associated charges. Non-compliance may result in corrective action plans.