How do I make a referral or request CCS services?
Referral forms are available:
Providers may request services for CCS clients using one of the following Service Authorization Request, or SAR, forms:
- New Referral CCS/GHPP Service Authorization Request (DHCS form 4488)
- Established Client CCS/GHPP Service Authorization Request (DHCS form 4509)
- Discharge Planning CCS/GHPP Service Authorization Request (DHCS form 4489)
How do I become a paneled provider?
Submit a CCS Panel Application online.
Providers will receive an immediate online approval or request for any additional documentation necessary to process their paneling applications. Providers may track their application status online with a unique tracking number.
Who do I call if I have a question about my claim?
If you have any questions, please call the Conduent Telephone Service Center, also known as TSC, at 1(800) 541-5555. If you need further assistance, obtain a ticket number from TSC, and request your representative review your claims with you. The representative can arrange an office visit, as needed.
CCS claims are not adjudicated by CCS. All claims are processed through Conduent, the state of California fiscal intermediary. Claims issues should be directed to Conduent. Providers are encouraged to attend the Medi-Cal Providers Trainings, which are offered on a regular basis throughout the state. Dates and locations of training are available on the Medi-Cal Learning Portal.
Why was my claim denied? What do I do if my claim is being denied?
Review the Remittance Advice Details (RAD). Correct any errors and resubmit your claim accordingly.
If you have any questions, please call the Conduent Telephone Service Center, or TSC, at 1(800) 541-5555. If you need further assistance, obtain a ticket number from TSC and request your representative to review your claims with you. The representative can arrange an office visit, as needed.
What do I need to do to get paid?
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. However, claims sharing a CCS Approved Special Care Center’s SAR are exempt from this requirement.
Ensure the date of services being billed falls within the approved dates approved on the SAR.
If you are billing for inpatient services, use the physician or SCC SAR. Hospital SARs are restricted to hospital inpatient days only.
If you have any questions, please call the Telephone Service Center at 1(800) 541-5555.
How do I view my authorizations/SARs online?
- Complete the Application for Provider Electronic Data Interface, which is also known as PEDI.
- Fax: (916) 440-5346, or scan and email [email protected].
- Pending, approved, and denied SARs are viewable in real-time.
- Each user must have their own log-in password.
- Remember to include all individual National Provider Identification (NPI) numbers associated with Group NPIs and Special Care Center affiliations on your PEDI application so that all possible client SARs are accessible.
What is the BIN# for CCS?
Use BIN# 610442, otherwise the claim will deny.
My office has moved. What do I need to do?
Enrolled providers are responsible for notifying DHCS within 35 days of any change to their previously submitted information. Please refer to the items listed on the Medi-Cal Supplemental Changes (DHCS 6209) form.
If the change in information you need to report does not appear on this form, then you are required to submit a new complete application package, according to your provider type. One exception to this requirement is that a currently enrolled individual physician or osteopath who is changing their business location within the same county may submit the Medi-Cal Change of Location Form for Individual Physician Practices Relocating within the Same County (DHCS 9096).
Please make sure you update addresses including phone numbers for all group, individual, and rendering/indirect Medi-Cal/ National Provider Identification (NPI) numbers.
You may contact the PED message center at (916) 323-1945 or by email at [email protected] if you have questions about which forms are required to report your specific change.
What is a Service Code Group, or SCG?
An SCG allows providers to render multiple services for a CCS authorized client without the submission of a separate SAR for each service. An SCG removes barriers to providing services for CCS clients and is intended to facilitate health care delivery to the CCS client. Check your SAR to determine if SCG has been granted and if the code is already covered within the SCG.
Note that though all FDA-approved drugs are contained in the Service Code Groupings (excluding drugs that require specific authorization by CCS), all the drugs do not appear in the lists due to space constraints. A complete list of drugs that require specific authorization by CCS can be found on the Medi-Cal website.
Most surgical procedures are not included in Service Code Groupings and requires separate SAR approval.
What drugs and supplies require a separate authorization?
Product specific SARs must be issued for insulin syringes, diabetic test strips and lancets. Provider must use NDC#s or supply code listed on SAR.
If the pharmacy is billing for low-cost medical supplies and/or low-cost DME and they have exceeded the Medi-Cal maximum allowed they will need to request a product specific SAR. Verify that the SAR covers the date of service. Medical justification is needed for amounts exceeding the Medi-Cal allowable.
Brand name medications require a separate SAR and medical justification as to why the generic medication cannot be used.
Why doesn’t the client’s number come up when I try to enter it?
Does your system require a 14 digit or 9 digit CIN#? Medi-Cal only accepts a CIN that begins with a nine and ends with an alphabetical character.
Verify entry of the correct CIN# and BIC issue date. The last 5 digits of the CIN# can change if the client lost their card and was issued a new one.
Select the CIN# number that covers the date of service.
Why doesn’t my claim for medical supplies go through?
NDC#/Supply code to bill for medical supplies that require HCPCS codes.
If the pharmacy does not have the appropriate software to bill using HCPCS codes to bill for supplies, contact TCS at 1(800) 541-5555 and select the option for POS, Internet, LSRS and CMC inquires.
How do I obtain Service Authorization Request, or SAR, information when I am not the authorized provider?
- Lab, x-ray and anesthesiology generally share a physician or Special Care Center SAR. Please ask the family for a copy of the SAR at the time of service or ask the ordering physician for the same SAR information that the referring physician is using for billing.
- Services must be related to the CCS eligible condition.
- If the code is not within the authorized Service Code Group, a separate SAR is needed.
- When using form 1500, enter the SAR number in field 23 Prior authorization number and do not enter a referring provider or NPI in field 17/17b when sharing a Special Care Center SAR.
- If you have billing questions, please call the Telephone Service Center at 1(800) 541-5555.
- Please submit your claim directly to the State of California Fiscal Intermediary at the following address:
820 Stillwater Road
West Sacramento, CA 95605-1630