123929 Guide

The denial must state the specific reason (e.g., "service does not treat the CCS eligible condition").

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

In the context of California health and safety laws, concerns the prior authorization process for services provided under the California Children's Services (CCS) program. The denial must state the specific reason (e

Section 123929 establishes that services provided to a child through the CCS program generally require from the department or its designated agency. This means that before a medical service, piece of equipment, or treatment is provided, a Service Authorization Request (SAR) must be submitted and approved. 2. The SAR Process The Core Mandate: Prior Authorization In the context

While "prior" authorization is the rule, certain emergency services may be authorized retroactively if they meet specific criteria defined in the CCS Manual of Procedures. 4. Denials and Appeals If a SAR is denied under Section 123929:

Providers receive a Notice of Action (NOA) through the Provider Electronic Data Interchange (PEDI). 3. Key Considerations for Approval

The provider submits a SAR via the CMS Net portal or through designated county forms.