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  • Form: Established Ccs/ghpp Client Service Authorization Request ... - Files Medi-cal Ca

Get Form: Established Ccs/ghpp Client Service Authorization Request ... - Files Medi-cal Ca

State of California--Health and Human Services Agency Department of Health Care Services California Children's Services/Genetically Handicapped Persons Program ESTABLISHED CCS/GHPP CLIENT SERVICE.

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How to fill out the Form: Established CCS/GHPP Client Service Authorization Request online

This guide provides comprehensive instructions on how to complete the Established CCS/GHPP Client Service Authorization Request form effectively. By following the outlined steps, users can ensure accurate submission for client service authorization.

Follow the steps to fill out the form online.

  1. Click ‘Get Form’ button to obtain the form and open it in your preferred document editor.
  2. Enter the date of request in the provided field. This should reflect the current date when you are making the request.
  3. Fill in the provider information: enter the provider's name, provider number, complete address, contact person, contact telephone number, and fax number in the respective fields.
  4. In the client information section, provide the client’s name (last, first, and middle), gender, date of birth, CCS/GHPP case number, client index number (CIN), and client’s Medi-Cal number.
  5. Indicate the diagnosis by entering the relevant diagnosis codes in the designated field. This may include multiple ICD-9 codes if necessary.
  6. Specify if the authorization request is for a new CCS/GHPP SAR or an extension of an existing one. If it is an extension, include the authorization number.
  7. For requested services, enter the CPT-4/HCPCS code or NDC code as required, the specific description of the service, and the desired service dates.
  8. In the frequency/duration section, indicate how often the service is needed. Also, list the quantity for each procedure.
  9. If applicable, check the box to indicate if other documentation is attached and provide the facility name where services will be performed.
  10. For inpatient hospital services, complete the related fields such as begin and end dates, number of days, extension dates, and the number of extension days, if applicable.
  11. If additional services from other healthcare providers are requested, provide their information including name, provider number, contact details, and the description of services.
  12. Once all information is filled out, ensure that the form is signed by the physician or authorized representative before entering the date of the signature.
  13. Finally, save your changes, download, print, or share the completed form as necessary.

Start filling out your documents online today for seamless service authorization.

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CCS authorization is the official approval needed to obtain medical services under the California Children's Services program. This authorization confirms that the specific medical services requested meet the program’s criteria. By completing the Form: Established CCS/GHPP Client Service Authorization Request ... - Files Medi-cal Ca, you can efficiently navigate the authorization process and secure necessary approvals for your child's care.

CCS is used to provide medical care and related services for children who have certain qualifying conditions that require specialized treatment. This can include access to specialized doctors, therapies, and necessary medical equipment. By utilizing the Form: Established CCS/GHPP Client Service Authorization Request ... - Files Medi-cal Ca, you ensure that your child receives timely and appropriate support.

A CCS call typically involves contacting the CCS program for assistance regarding services or authorizations for children with serious health conditions. This can help clarify your queries about the processes or services available. Using the Form: Established CCS/GHPP Client Service Authorization Request ... - Files Medi-cal Ca can streamline your inquiries and assist in obtaining the necessary support.

A CCS SAR number, or Service Authorization Request number, is assigned to your specific request for authorization within the CCS framework. This number allows Medi-Cal to track and manage your request efficiently. When completing the Form: Established CCS/GHPP Client Service Authorization Request ... - Files Medi-cal Ca, noting your CCS SAR number is essential for smooth processing.

CCS information refers to the data and guidelines provided under the California Children's Services program. This program offers medical services for children with certain serious ailments. If you are navigating the Form: Established CCS/GHPP Client Service Authorization Request ... - Files Medi-cal Ca, understanding CCS information helps in ensuring you gather the necessary details to facilitate access to services.

How do I view my authorizations/SARs online? Fax: (916) 440-5346, or scan and email cmshelp@dhcs.ca.gov. Pending, approved, and denied SARs are viewable in real-time.

Fax Submission Pharmacy providers and prescribers can submit a PA request via fax by utilizing the following approved forms: 50-1, 50-2, 61-211, or the Medi-Cal Rx PA Request Form, available January 1, 2022, in Reference Materials at .medi-calrx.dhcs.ca.gov/provider/forms/.

A. CCS manages specialty care for medically eligible conditions that your Medi-Cal plan may not cover. Medi-Cal covers primary care and any specialty care not covered by CCS.

Providers will submit appeals of PA adjudication results, clearly identified as appeals, via fax (800-869-4325), the Medi-Cal Rx provider web portal, or they can be mailed to: Medi-Cal CSC, Provider Claims Appeals Unit P.O. Box 610 Rancho Cordova, CA, 95741-0610.

Urgent requests for prior authorization should be called in as soon as the need is identified. Medication prior authorization requests may be submitted by fax using the Prescription Drug Prior Authorization or Step Therapy Exception Request Form (No. 61-211) – English (PDF).

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232