26-1066 Refer Eligible Members to CCS and Use CCS-Paneled Providers

Date: 09/09/26

Requirements for Medi-Cal members under age 21 with CCS-eligible conditions

Providers caring for Medi-Cal members under age 21 with California Children’s Service (CCS)-eligible medical conditions are required to:

1. Identify members who may be eligible for CCS as early as possible.
2. Refer eligible members to CCS through the member's local CCS county office.
3. Submit Service Authorization Requests (SARs), as applicable:

• For members new to CCS, complete the New CCS/GHPP Client Service Authorization Request (SAR) form (PDF).
• For members already enrolled in CCS, complete the Established CCS/GHPP Client Service Authorization Request (SAR) form (PDF).
• Verify that treating providers are CCS-paneled before services are rendered, unless the service is provided in a limited emergency situation.

Compliance requirements and financial responsibility

Failure to comply with CCS requirements may result in:

• A corrective action plan.
• Denied claims: Health Net is not financially responsible for services provided to treat CCS-eligible conditions.
• Provider being held financially responsible for any related services and associated charges.

Regulatory and contractual requirements

CCS requirements are outlined in Section 4.3.14 of the California Children's Services (CCS) program requirements. Per your Provider Participation Agreement (PPA), physicians, practitioners and other providers must comply with all state and federal requirements.

CCS tools and resources

• County office list for CCS
• CCS-paneled provider lists
• CCS provider training
• CCS PEDI application

Interested in becoming a CCS-paneled provider?

Providers interested in becoming a CCS-paneled provider may contact the California Department of Health Care Services (DHCS) Provider Enrollment Unit:

• Email: Provider Paneling
• Phone: (916) 552-9105, option 5, then option 2
• Online application: CCS Online Paneling Application

Need help? Contact us

For questions about CCS referrals, provider paneling requirements or CCS processes, contact the CCS Liaison Team at 844-925-0962, or CCS directly using the CCS county office list for the county where the member resides.

For all other questions, contact Community Health Plan of Imperial Valley at 833-236-4141.

 

This information applies to Physicians and Practitioners, Participating Physician Groups (PPGs), Hospitals, and Ancillary Providers.

This information applies to Medi-Cal in Imperial County.