Problem Resolution

County California Children's Services (CCS) program staff determine medical eligibility, limit authorization to CCS-paneled providers, review proposed treatment plans to determine necessity, and authorize services. Problems that arise involving the CCS program, Health Net, the participating physician group (PPG), and the primary care physician (PCP) are resolved by Health Net's public programs administrators. During any problem periods, the Health Net Health Services staff and the PCP or specialty physician continue to coordinate the medical care of the member.

The Health Net public programs administrators produce monthly CCS Reconciliation Reports to assist in tracking CCS referrals and active cases for coordination. They also meet routinely with CCS liaisons to identify and resolve areas of procedural concern on a local level and exchange client and provider listings and program and policy updates. The public programs administrators also collaborate with the local CCS programs to provide educational opportunities to participating providers.