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Providers use the Service Authorization Request (SAR) to seek approval. The process typically follows these steps:

Families have the right to request a Fair Hearing or an informal grievance review if they disagree with the authorization decision. 5. Interaction with Medi-Cal For children who are dually eligible for Medi-Cal and CCS:

Below is a guide to understanding the requirements and implications of this section based on the CCS Administrative Case Management Manual. 1. The Core Mandate: Prior Authorization 123929

If CCS denies a service because it is not for the eligible condition, the provider may then need to seek authorization through the standard Medi-Cal process (e.g., via a Treatment Authorization Request).

Providers receive a Notice of Action (NOA) through the Provider Electronic Data Interchange (PEDI). 3. Key Considerations for Approval Providers use the Service Authorization Request (SAR) to

The service must directly treat the CCS-eligible condition or a complicating condition associated with it.

A formal denial notice (NOA) must be sent to the family and the provider. Interaction with Medi-Cal For children who are dually

Documentation must prove the requested service is the most appropriate and cost-effective treatment.