Medi-Cal: Billing Tips: California Children's Services (CCS)

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Billing Tips

Billing Tips: California Children's Services (CCS)

General Reminders

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. (SARs issued to a CCS Approved Special Care Center’s Identification Number is exempted from this requirement).
Ensure the date of services being billed falls within the approved dates approved on the SAR.

Remittance Advice Details (RAD) Claim Denials

RAD code 9660: Services for CCS/GHPP-only (California Children’s Services/Genetically Handicapped Persons Program) recipients cannot be billed under a contract facility ID (identification) number. Resubmit with the non-contract provider ID number.

Verify recipient’s eligibility.
If the recipient has non-covered restricted services or no Medi-Cal eligibility, submit the inpatient claim using the non-contract provider number.

RAD code 9662: SAR (Service Authorization Request) status is not active, contact client’s CCS (California Children’s Services) or GHPP (Genetically Handicapped Persons Program) office.

Verify the effective date of the cancelled SAR.
Contact the Telephone Service Center (TSC) to verify the status and effective dates of SAR.
Contact the CCS County to verify the effective dates of the cancelled SAR.

RAD code 9664: Provider is not authorized for CCS/GHPP (California Children’s Services/Genetically Handicapped Persons Program) service for this client.

Ensure the billing or rendering provider number matches the authorized provider’s number on the SAR.
If you are sharing another provider’s SAR, ensure the authorized provider’s number is indicated as the referring provider number on the claim.

RAD code 9665: Invalid CCS/GHPP (California Children’s Services/Genetically Handicapped Persons Program) provider number. Resubmit with Medi-Cal provider number.

Claim(s) submitted for payment must be billed with an active Medi-Cal provider number.
CGP (CCS/GHPP-only) provider numbers should not be used.

RAD code 9667: Restricted drug billed is not authorized by CCS (California Children’s Services) or GHPP (Genetically Handicapped Persons Program).

Restricted drugs are not billable with a SCG SAR.
For a list of drugs that require a separate SAR, refer to the California Children’s Services (CCS) Program Service Authorization Request (SAR) section. These drugs must be listed on the SAR with the provider’s number.
Verify that the hard copy SAR has the NDC listed and the pharmacy provider number listed.

RAD code 9668: SAR (Service Authorization Request) for CCS/GHPP (California Children’s Services/Genetically Handicapped Persons Program) service is not found on SAR file for date billed.

Wait 24 hours from the date the SAR was issued before billing for authorized services.
Verify the dates approved on the SAR.
Verify that the SAR number on the claim matches the SAR number from the hard copy SAR.
Contact the TSC to verify that the SAR number is correct. If not, refer back to the CCS County where the recipient resides.

RAD code 9669: CCS/GHPP (California Children’s Services/Genetically Handicapped Persons Program) claim recipient does not match the SAR (Service Authorization Request) recipient.

Submit the claim with the Client Index Number (CIN) on the SAR (exception: submit the claim with the mother’s CIN when billing for a newborn using the mother’s CIN).

RAD code 9670: Claim date of service does not match date of service on SAR (Service Authorization Request) file.

Ensure the date of service billed falls within the approved dates on the SAR.
Call and verify this information with the TSC.

RAD code 9671: Procedure code has not been authorized by CCS/GHPP (California Children’s Services/Genetically Handicapped Persons Program).

Verify procedure code(s) billed on the claim were authorized on the SAR or were included in SCG authorized on the SAR.
Verify the amount of units billed is approved on the SAR.

RAD code 9673: Date of service is outside the authorized period on SAR (Service Authorization Request).

Verify the approved dates on the hard copy SAR and ensure you are not billing outside of those dates.
Contact the TSC to verify the dates on the SAR file.

If you have any questions, please call the Telephone Service Center (TSC) at 1-800-541-5555.

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