Children's Medical Services Network (CMS Net) Provider Electronic Data Interchange (PEDI)
The Children’s Medical Services (CMS) developed a web-based tool that enables approved CCS providers, Medi-Cal Managed Care Plans and Healthy Family Plans to electronically access the status of Requests for Services/Authorizations. In addition to viewing authorizations each approved facility shall have the ability to print authorizations, denials and Notices of Action.
Forms and Manuals
CCS providers/plans/facilities wishing to participate in the CMS Net PEDI shall be aware of the following facts and requirements upon applying for access:
- The information obtained through the CMS Net PEDI is real time.
- The site that shall be used to access the CMS Net PEDI is best supported with Internet Explorer 8. If an alternate Internet Browser is used the State Information Technology Section (ITS) cannot guarantee results.
- Each provider or plan shall have a designated PEDI liaison(s) that shall be responsible for all communication with the State Information Technology Section (ITS) for coordination of users within the organization and dissemination of PEDI id’s and passwords. The PEDI liaison(s) shall also be responsible for notifying the ITS of staffing changes (provider separation, user modification, etc.) including status of their position. Such requests shall be submitted on the attached account request forms.
- Each provider or plan must have internal agreements at their site between services including, but not limited to: Inpatient Services, Outpatient Clinics, Emergency Services, CCS and GHPP approved Special Care Centers, and Billing services regarding the internal distribution of CCS and GHPP service authorizations.
- Each provider or plan must assure that they have written permission from the providers within their domain to access the providers’ individual authorizations. (This requirement is not applicable to health plans.)
- If the provider/plan is approved for PEDI, the County and or/Regional Office will not provide hard copies of SARs, NOAs or other correspondence related to cases. Exceptions to this rule may be made for newborns using mom’s Medi-Cal eligibility and technical malfunctions.
- For Managed Care Plans (MCP) and Healthy Families (HF) Plans that subcontract with another Health Care Provider or Plan, the PEDI enrolled Plan is responsible for providing the SARs, NOAs or other applicable information to the subcontracted plan or must request a PEDI ID and password for the subcontracted plan as applicable.
- Where feasible each provider or plan must be willing to enter into reciprocal agreements with State and local CCS programs permitting electronic access to medical information regarding CCS and GHPP beneficiaries.
- Each provider/plan/facility must forgo having CCS or GHPP send a hard copy of all authorizations, denials and Notices of Action.
Download PEDI Application
Pharmacy Providers- Pharmacy providers are approved on a case-by-case basis. Pharmacy providers will have access to SARs issued to their specific National Provider Identifier (NPI), which includes CCS-restricted drugs, enteral nutrition products, and certain medical supplies. Pharmacy providers will not have access to view SARs issued to Physicians or Special Care Centers with Service Code Groupings (SCG 01, 02 etc.).
Forms and Manuals
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