20-669 Learn When to Coordinate Care with California Children's Services

Date: 09/04/20

Help reduce member concerns and denied claims

After a member has established eligibility in the California Children’s Services (CCS), the CCS program assumes case management responsibilities. This includes prior authorization and payment for all services related to the CCS-eligible medical condition and care for newborn stabilization prior to transfer to a CCS-approved neonatal intensive care unit (NICU).

All care in the CCS program must be given by CCS-paneled providers and in a CCS-approved facility for CCS to make payment, with the exception of certain trauma care.

Get a prior authorization

The CCS program issues an authorization after it reviews the request for services and determines medical eligibility. All services, except emergency and after-hour services, require prior authorization. The independent practice association (IPA) continues to provide all medically necessary covered services to the member until CCS eligibility is confirmed.

CCS-eligible NICU patients

Authorization for a CCS-approved NICU facility also authorizes related NICU physician services and fees. A separate authorization process for NICU physician services is not needed. This does not apply to a CCS-paneled surgeon who performs surgery on an infant in a CCS-approved NICU.

What care does the PCP give CCS-eligible members?

The primary care physician (PCP) remains responsible for providing primary care services to the member and care for medical conditions not eligible for or covered by the CCS program. This includes coordinating with CCS and CCS-paneled specialists to ensure continuity of care for those conditions that are covered by the CCS program.

When is the IPA involved?

The IPA continues to provide all medically necessary covered services to the member until CCS eligibility is confirmed.

Emergency care with inpatient admission

When an inpatient admission for emergency treatment is required and the hospital is not CCS-approved, the IPA must coordinate care.

• Referrals for the emergency inpatient admission must be made to the county CCS program on the next business day and must include documents proving the need for emergency care.
• Once the member is stabilized, the IPA must ensure the member is transferred to a CCS-approved hospital.

Request assistance, training and more information

• Participating providers and care managers can call the California Health & Wellness Plan (CHWP) Public Programs Department at 1-844-966-0478 to request assistance with Service Authorization Request (SAR) referrals and CCS training.
• More information about coverage, SAR forms, referrals, and claims billing is found in provider update 20-524, distributed on July 8, 2020.

Online resources

You can also use the following links and references:

• You can view the Paneled Provider Lists from the California Children's Services website.
• Become a CCS Paneled Provider by following the instructions on the California Children's Services Provider Enrollment webpage. 
• Regulatory Requirements: California Code of Regulations, Title 22, Sections 41510, 41515.1, 41770, and 51013.
• Refer to the California Code of Regulations, Title 22, Division 2, Part 2, Subdivision 7, CCS, Chapter 4, Medical Eligibility, Article 4, available on the Calregs website.

Additional information

Please visit California Children's Services website for more information.

More information about CCS and County CCS office contact information is found in the Calfornia Health & Wellness Provider website, including the forms mentioned in this update. To get forms, go to For Providers > Provider Resources > Manuals, Forms and Resources > More Resource Topics > California Children’s Services (CCS).  Or, for more information, go to For  Providers > Provider Resources > Manuals, Forms and Resources > Manuals > Provider Manual / Billing Manual (PDF) and search for CCS.

If you have questions about the information in this update, contact CHWP at 1-877-658-0305.