New Referral CCS GHPP Client Service Authorization Request (SAR) DHCS 4488 - dhcs ca-2025

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The document is a service authorization request form for the California Children's Services/Genetically Handicapped Persons Program, detailing the necessary information required from providers and clients to process requests for medical services. It includes sections for provider and client information, insurance details, diagnosis, requested services, and additional documentation requirements.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the 'Date of request' at the top of the form. This is essential for tracking your submission.
In the 'Provider Information' section, fill in your name, provider number, and contact details. Ensure accuracy for seamless communication.
Next, move to 'Client Information.' Enter the client's full name, date of birth, and contact information. Be sure to include their residence address without using a P.O. Box.
For 'Insurance Information,' indicate if the client is enrolled in Medi-Cal or a commercial insurance plan. Provide necessary identification numbers as required.
In the 'Requested Services' section, specify the services needed by entering relevant codes and descriptions. Include start and end dates for service requests.
Finally, ensure that all required fields are completed before signing at the bottom of the form. This confirms that all information provided is accurate.

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Versions	Form popularity	Fillable & printable
2015	4.8 Satisfied (146 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is a CCS SAR number?

A SAR, or Service Authorization Request, is an authorization from CCS to allow medical providers to bill for services related to your childs CCS-eligible condition.

What is SAR for medical?

Also known as subacute care or SAR, sub-acute rehab usually refers to an intermediate stage between acute care and skilled nursing care. It is a form of rehabilitation that aims to improve patients health and optimize their functioning.

Is CCS the same as Medi-Cal?

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.

What is CCS authorization?

The CCS program requires prior authorization for services. This means that a Service Authorization Request (SAR) must be submitted to the CCS State office for approval for all diagnostic and treatments services, except for emergencies.

What is CCS DHCS?

CCS is a statewide program that treats children with certain physical limitations and chronic health conditions or diseases. CCS can authorize and pay for specific medical services and equipment provided by CCS-approved specialists. The California Department of Health Care Services (DHCS) manages the CCS program.

ccs referral form

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What is an SAR number?

The FAFSA Submission Summary, formerly known as the Student Aid Report (SAR), can tell you about your financial aid eligibility, potential schools, making corrections or changes to your FAFSA form, and next steps as you prepare to receive aid offer letters.