26-1065 Refer Eligible Members to CCS and Use CCS-Paneled Providers

IMMEDIATELY: Billing and clinical teams must implement the following workflow changes: (1) Update intake/eligibility processes to identify all Medi-Cal members under age 21 and screen for CCS-eligible conditions; (2) Implement referral process to local CCS county office for eligible members as early as possible; (3) Before scheduling or rendering ANY services for CCS-eligible conditions, billing staff must verify that the treating provider is CCS-paneled using Health Net's CCS-paneled provider lists; (4) For new CCS members, billing staff must ensure Service Authorization Requests (SARs) are submitted using the New CCS/GHPP Client Service Authorization Request form; (5) For established CCS members, use the Established CCS/GHPP Client Service Authorization Request form; (6) Update billing system to flag Medi-Cal members under 21 for CCS eligibility screening and paneling verification; (7) Train all front-desk, eligibility, and billing staff on CCS requirements and referral procedures. CONSEQUENCES: Claims for CCS-eligible condition services provided by non-paneled providers will be DENIED, and Health Net will NOT be financially responsible—the provider will be held liable for all related charges. Failure to comply may trigger corrective action plans.