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Billing Tips: California Children's Services (CCS)
- Always ensure that the service code submitted on the claim is authorized on the Service Authorization Request (SAR) or included in the authorized Service Code Grouping (SCG).
- If you are sharing another provider’s SAR, ensure the authorized provider number is indicated as the referring provider on the claim. (SARs issued to a CCS Approved Special Care Center’s Identification Number is exempted from this requirement).
- Ensure the date of services being billed falls within the approved dates approved on the SAR.
Remittance Advice Details (RAD) Claim DenialsRAD code 9660: Services for CCS/GHPP-only (California Children’s Services/Genetically Handicapped Persons Program) recipients cannot be billed under a contract facility ID (identification) number. Resubmit with the non-contract provider ID number.
- Verify recipient’s eligibility.
- If the recipient has non-covered restricted services or no Medi-Cal eligibility, submit the inpatient claim using the non-contract provider number.
- Verify the effective date of the cancelled SAR.
- Contact the Telephone Service Center (TSC) to verify the status and effective dates of SAR.
- Contact the CCS County to verify the effective dates of the cancelled SAR.
- Ensure the billing or rendering provider number matches the authorized provider’s number on the SAR.
- If you are sharing another provider’s SAR, ensure the authorized provider’s number is indicated as the referring provider number on the claim.
- Claim(s) submitted for payment must be billed with an active Medi-Cal provider number.
- CGP (CCS/GHPP-only) provider numbers should not be used.
- Restricted drugs are not billable with a SCG SAR.
- For a list of drugs that require a separate SAR, refer to the California Children’s Services (CCS) Program Service Authorization Request (SAR) section. These drugs must be listed on the SAR with the provider’s number.
- Verify that the hard copy SAR has the NDC listed and the pharmacy provider number listed.
- Wait 24 hours from the date the SAR was issued before billing for authorized services.
- Verify the dates approved on the SAR.
- Verify that the SAR number on the claim matches the SAR number from the hard copy SAR.
- Contact the TSC to verify that the SAR number is correct. If not, refer back to the CCS County where the recipient resides.
- Submit the claim with the Client Index Number (CIN) on the SAR (exception: submit the claim with the mother’s CIN when billing for a newborn using the mother’s CIN).
- Ensure the date of service billed falls within the approved dates on the SAR.
- Call and verify this information with the TSC.
RAD code 9671: Procedure code has not been authorized by CCS/GHPP (California Children’s Services/Genetically Handicapped Persons Program).
- Verify procedure code(s) billed on the claim were authorized on the SAR or were included in SCG authorized on the SAR.
- Verify the amount of units billed is approved on the SAR.
- Verify the approved dates on the hard copy SAR and ensure you are not billing outside of those dates.
- Contact the TSC to verify the dates on the SAR file.
If you have any questions, please call the Telephone Service Center (TSC) at 1-800-541-5555.