授权流程​​ 

All requests for CCS diagnostic and treatment services must be submitted using a Service Authorization Request (SAR) form except Orthodontic and Dental services (All necessary authorizations will be Medi-Cal Dental’s responsibility). Only active Medi-Cal Providers may receive authorization to provide CCS program services. Services may be authorized for varying lengths of time during the CCS client’s eligibility period.​​ 

提交 SAR 时的一些有用提示：​​ 

• Providers must request CCS services using a
  SAR form.
  Note: Providers should verify CCS eligibility before submitting a SAR.​​ 
• Providers are required to submit documentation to substantiate medical necessity at the time the SAR is submitted. Send the completed SAR form with supporting documentation to the appropriate CCS county or Regional Office via fax or mail. Examples of required supporting documentations include prescriptions, clinic visit reports, physical therapy evaluation reports, etc. A SAR without supporting documentation will be deferred back to the provider for additional information.​​ 
• 提交给 CCS 的每份 SAR 都会接受医疗必要性的审查。​​ 

如何避免 CCS 服务遭拒​​ 

CCS 计划要求对服务进行事先授权。 这意味着必须向 CCS 州办公室提交服务授权请求 (SAR) 以获得所有诊断和治疗服务的批准，紧急情况除外。 紧急服务的授权申请必须在服务日期后的下一个工作日结束前提交给 CCS。​​ 

索赔处理​​ 

除非客户居住在纳帕、圣马特奥、圣巴巴拉、圣路易斯奥比斯波、索拉诺、马林或尤洛县，否则已由 CCS 授权的服务索赔应直接提交给 Gainwell Technologies。 居住在这些县的客户由县组织的健康系统 (COHS) 提供服务，该系统已与该部门签约，作为 Medi-Cal 财政中介为这些县提供服务。​​  

Kaiser Permanente 将负责为在 Kaiser Permanente 登记的符合 Medi-Cal 资格的 CCS 儿童和青少年提供护理，并将在 WCM 项目目前存在的以下县实施 WCM 项目：马林县、纳帕县、奥兰治县、圣马特奥县、圣克鲁斯县、索拉诺县、索诺玛县和尤洛县。 CCS 是针对这些县通过 Kaiser Permanente 接受医疗保健服务的会员提供的按人头计费的服务，服务有效期为 2024 年 1 月 1 日或之后。​​ 

• 提交已获 CCS 批准或授权的服务索赔。 未经 CCS 批准或事先授权的服务索赔可能会被拒绝。​​ 
• 向已确认有资格获得 CCS 福利的客户提交所提供服务的索赔。 向非 CCS 客户或不再有资格获得 CCS 福利的客户所提出的服务索赔将被拒绝。​​ 
• 及时向施乐公司或 COHS 提交索赔。​​ 
• 提交为具有其他健康保险的客户提供的服务的索赔，并在索赔中附上福利说明 (EOB)。​​ 
• 提交向以下县的客户提供的所有服务索赔：​​ 
  • Napa, Solano, Marin or Yolo:
    Partnership Health Plan of California
    P.O. Box 1368
    Suisun, CA 94585​​ 
  • San Mateo:
    ALL CCS and HF CLAIMS STRAIGHT TO EDS
    ALL MEDI-CAL CLAIMS TO SAN MATEO COUNTY CCS
    California Children’s Services
    2000 Alameda de las Pulgas       
    Suite 230
    San Mateo, CA 94403​​ 
  • San Luis Obispo and Santa Barbara:
    CENCAL Health
    P.O. Box 948
    Goleta, CA 93116-0948​​ 
  • For Northern California Kaiser Permanente Counties: Marin, Napa, San Mateo, Santa Cruz, Solano, Sonoma, and Yolo:
    Continuum Claims Processing CenterPO Box 12923Oakland, CA 94604​​ 
  • For claims sent Certified mail only for Northern California Kaiser Permanente: Marin, Napa, San Mateo, Santa Cruz, Solano, Sonoma, and Yolo:Kaiser Foundation Health Plan, Inc. National Claims Administration 1800 Harrison St., 12th FloorOakland, CA 9461​​ 
  • For Southern California Permanente Counties: OrangeKaiser Permanente Claims Administration Department PO Box 7004 Downey, CA 90242-7004​​ 

账单问题​​ 

If you have billing questions, please contact Medi-Cal at (916) 636-1980 (outside of California, please call (800) 541-5555). You can also visit the Medi-Cal website for billing procedures and updates.​​