MedicaidPrior AuthHigh impact
26-1066 Refer Eligible Members to CCS and Use CCS-Paneled Providers
Health Net·CA·Prior Authorization
We identified it
Sep 10, 2026
Summary
Health Net has implemented a mandatory CCS (California Children's Services) referral and provider paneling policy for Medi-Cal members under age 21 with CCS-eligible conditions. Providers must identify eligible members, refer them to their local CCS county office, submit appropriate Service Authorization Requests, and verify that treating providers are CCS-paneled before rendering services. Non-compliance may result in claim denials and provider financial responsibility for services provided to treat CCS-eligible conditions.
Action Required
Immediately: Billing and clinical staff must implement the following workflow changes: (1) Identify all Medi-Cal members under age 21 presenting with CCS-eligible conditions as early as possible in the encounter process; (2) Refer eligible members to CCS through their local CCS county office using the appropriate SAR form (New CCS/GHPP Client Service Authorization Request for new members, or Established CCS/GHPP Client Service Authorization Request for already-enrolled members); (3) Verify in the billing system and before service delivery that treating providers are CCS-paneled, unless providing limited emergency services; (4) Update encounter forms and pre-service checklists to include CCS eligibility screening questions; (5) Train billing and front-desk staff on CCS county office locations and referral procedures. Establish a compliance tracking mechanism to document all CCS referrals and SAR submissions. Consequences of non-compliance: Claims for CCS-eligible condition treatment will be denied, Health Net will not assume financial responsibility, and the provider will be held financially responsible for all related services and charges. A corrective action plan may also be imposed.