Effective July 1, 2019 the California Children’s Services (CCS) services will transition to the CalOptima Whole Child Model Program.
CCS is a statewide program providing medical care and case management for children under 21 with certain medical conditions that were locally administered by the Orange County Health Care Agency. Starting July 1, 2019, the Department of Health Care Services (DHCS) is implementing WCM to integrate CCS services into CalOptima for Orange County.
Whole Child Model goals:
- Combine CCS and Medi-Cal services under one managed care plan.
- Improve coordination of services to meet the need of the child and family.
- Maintain existing patient-provider relationships when possible.
- Retain CCS program standards.
- Improve overall health results.
- Improve access to care.
WCM Provider Training and Attestation
The Training can be located by:
- Please click on the Whole Child Model Training for training section.
- Please complete the training and submit the attestation form via fax to Provider Services at 714-947-8708.
WCM Services – Eligibility
Please contact Noble Mid-Orange County Member Services at 888-880-8811
WCM Services – Authorization Request
There are two ways to request Authorization(s):
1) Provider web portal (PCP only) at www.healthsmartmso.com.
- Click on [Provider Login] icon to access https://secure.prod.hsmso.net/hsmso.net/login.aspx
2) Fax Submission
Authorization (Urgent & Routine) request(s) can be submitted via fax to: 714-947-8700
WCM Services – Case Management
To reach our Case Management Department please call: 714-947-8600
- Fax Number: 714-947-8796
WCM Services – Claim Processing
For Customer Service claims inquiries for claims with date of services of July 1, 2019 and after please call: 714-947-8600.
Electronic Data Interchange (EDI)
Clearing House: Office Ally (OA) at 360-975-7000 press option #1
Payer ID: HSM01
Paper Claim Submission
Noble Mid-Orange County Claims Department
P.O. Box 6301
Cypress, CA 90630
Additional Information and Resources
- CalOptima: www.caloptima.org
- WCM Stakeholders Page: https://www.caloptima.org/en/CCS_Info.aspx
- WCM Member Page: https://www.caloptima.org/en/Members/Medical/WholeChildModel.aspx
- DHCS WCM Implementation Program Information: http://www.dhcs.ca.gov/services/ccs/Pages/CCSWholeChildModel.aspx
- CCS Advisory Group: https://www.dhcs.ca.gov/services/ccs/Pages/AdvisoryGroup.aspx
- California Welfare and Institutions Code 14094.4-.20
- DHCS All Plan Letter 18-011: Whole Child Model Program
- DHCS CCS Guidance: https://www.dhcs.ca.gov/services/ccs
- CalOptima WCM Provider FAQ: https://caloptima.org/~/media/Files/CalOptimaOrg/508/Providers/ProviderCommunications/ProviderFAQs/2019-06_FAQ_WCM_508.ashx