RTD reports are set to not display by default. Medi-Cal Dental Program - Members - Dental Managed Care - California . If you have billing questions, please contact Delta Dental at (800) 423-0507. In the Edit Claim window, under the General tab, type the following Claim Note: "Service description test". Secondary Policy Holders gender listed in their edit person screen. Note: For 5010 dental e-claims, the place of service on the claim cannot be 'office' and the site provider cannot be the same as the billing provider. If any bugs are discovered when testing, then please contact Open Dental. The share of cost in this example is 18. Most Denti-Cal users submit claims to a clearinghouse, which then submits to Denti-Cal. The page will refresh upon submission. Use this information to set up the Denti-Cal clearinghouse. The general test certification steps are as follows: Providers currently enrolled to submit electronically must update EDI enrollment to that of a direct submitter by completing the Provider Service Office Electronic Data Interchange Option Selection Form (OSF). CALIFORNIA MEDI-CAL DENTAL PROGRAM - Denti-Cal - State of - Yumpu In the Edit Claim window, under the Attachments tab, set the Attachment ID Number to "NEA#1234567". In the Edit Claim window, under the Misc tab, set the Correction Type to Replacement and the Original Reference Num to "123456789". This is entered in the Edit Claim window, Misc tab, under "Prior Authorization (rare)." Create a treatment planned procedure: a D0150 with fee 20. An appeal is the final step in the administrative process and a method for Medi-Cal providers with a dispute to resolve problems related to their claims. Please have the operator call the Toll-Free Member Line at 1-800-322-6384, Dental Managed Care (DMC) Dental Plan Directory, Helpful Information from American Dental Association (ADA) and California Dental Association (CDA), How to Avoid Inappropriate Care of Fraudulent Providers, How to Obtain Assistance in Getting Care or Resolving Problems with Dental Care. #1 all-in-one practice management solution. When a claim needs to be re-submitted, Denti-Cal sends back an electronic report called aResubmission Turnaround Document (RTD). When the claim associated with a TAR is submitted, Denti-Cal requires that the DCN be in included on it (sent in 2300 loop, REF G1 segment). Create and complete one procedure: a D0120 with fee 60. If it is checked the Practice Phone Number from Lists| Practice Information will print. California Medi-Cal Dental Program Occasionally (like in June-October of 2019) Denti-Cal requires communication testing when they make changes to their system. Only send the secondary Denti-Cal claim for testing purposes. ALL RIGHTS RESERVED. CALIFORNIA MEDI-CAL DENTAL PROGRAM BASIC & EDI SEMINAR PACKET Revised 6/20/12 B-PRL-TRN-006.H. We're committed to providing an extraordinary level of support and expertise for all your dental care needs. Based on employer preferences, the SSN pulls from the edit person screen OR the Id pulls from edit person | preferences. There are four basic steps to follow to submit claims electronically: Enter claim information Transmit data Retrieve and review reports and files returned from the Medi-Cal Dental Program Prepare and mail EDI labels - only for claims and TARs that require radiographs orattachments. Your file is uploaded and ready to be published. 2018 Patterson Dental Supply, Inc. All rights reserved. In the bottom left of the Procedure Info window, type "test note" into the E-claim Note. Edit Employer | Preferences | ID Dentist By. Patients Social Security Number listed in their edit person screen. We have now added the ability for you to access these reports on-demand through Curve Hero. Create and complete one procedure: a D1351 with fee 130. Based on employer preferences | ID Policy Holder By. CHDP Child Health and Disability Prevention? Set the date for the D0120 to today's date, and set the date for the D1351 to yesterday's date. Based on employer preferences above, the SSN pulls from the edit person screen OR the Id pulls from edit person |preferences. Not all electronic insurance claims systems work seamlessly together. Provider On Insurance selected in the Edit Provider screen for the Provider on Walkout, In their Edit Provider Screen | Identification | Federal Tax ID, Name/Address of Facility Where Services Were Rendered. At least one transaction that includes an Other Health Coverage amount. For login and registration support, submit a web support request. Offices may submit claims directly to Denti-Cal using the process outlined below. california medi-cal dental program. Following review, EDI Support will let you know if there is anything wrong with the batch, or if additional test claims are needed. Sacramento, CA 95852-1539, Medi-Cal Dental Member Contact Information. Only applies if patient has Secondary Insurance. Patient Portion from treatment plan (only for preauthorization), Estimated Insurance from treatment plan (only for preauthorization), Denti-Cal DC-017A Claim Form Specifications. Back to top. PDF Appeal Form Completion (appeal form) - Medi-Cal Other Carrier Name, Address, City, State, Zip Code. In the Edit Claim window, under the General tab, type the following Claim Note: "Other Health Coverage test". Based on employer preferences, ID Patient By Does not populate if box #18 is marked as SELF and ID Patient By in employer preferences is marked to None. Please have the operator call the Toll-Free Member Line at 1-800-322-6384. In the Edit Claim window, under the General tab, type the following Claim Note: "Claim test". Is Patient's Condition Related To: Other Accident? Denti-Cal will request that you submit one 837D claim transaction to Denti-Cal using Tumbleweed (a secure email). To contact the Medi-Cal Dental Program, please call the Member Telephone Service Center at (800) 322-6384. If the Billing Entity is blank, the provider on insurance first and last name info from their edit provider screen will appear. This preference will dictate where it should be entered under the Provider On Insurance selected in the Edit Provider screen for the Provider on Walkout, In their Edit Provider Screen | Identification . Denti-Cal website address EDI support Medi-Cal Dental Forms Once a provider enters the full testing phase (step 4), Denti-Cal will issue a Login ID (Remote ID) and password. To send the test batch, in the Manage module, clickSend Claims. To send the service facility information (site place of service, address and NPI), follow these steps. Edit the Insurance that is attached to the secondary policy holder. *Will need to change in Service Code List under the services ADA Code. For more information about your dental managed care plan choices, please visit Health Care Options, Medi-Cal Dental Policy Holders gender listed in their edit person screen. To learn more about how you can get involved, please contact our Provider Customer Service line at (800) 423-0507 or visit the Medi-Cal Dental Provider Outreach website for more information. Create and complete one procedure: a D0140 with fee 57. Secondary Policy Holders name listed in their edit person screen. Enter the information below, using the Remote ID and password supplied by Denti-Cal. This is a replacement of the Laser Claim Form (DC-017A) and TAR (DC-017B) and is requiredfor paper claims by April 1, 2008. SN Cs will submit the claim form found on the Denti-Cal website, to the Dental FI for the initial and subsequent CRA procedure bundles, as well as the following services: Dl354, Dl206 or Dl208, Dl 120, D0120, D0145, or D0150, per the CRA risk levels. If printing forms, here are the downloads for the 2008 Denti-Cal claimform: DC-217.gif - background image for all versions. In their Edit Provider Screen | Identification | License Number. In the Edit Claim window, under the General tab, type the following Claim Note: "TAR test". You should contact Denti-Cal to schedule testing. Conduct a preliminary test with Denti-Cal. At least one transaction reflecting a non-employment related accident. city, state. denti-cal. Larger offices may want to submit directly to Denti-Cal, because there is a fee per claim when using a clearinghouse. During the testing phase, you can still use your existing clearinghouse (e.g. Medi-Cal covers dental services that are provided through Denti-Cal. Patients gender listed in their edit person screen. How Much Does It Cost? Performing this action will revert the following features to their default settings: Hooray! The Remote ID starts with the letters DC. The SSN pulls from the edit person screen OR the Id pulls from edit person | preferences on the Policy Holder. You can find the DCN on the approval notice or "NOA" that was sent by Denti-Cal. Patient's or Authorized Person's Signature, In Patients Edit Person screen under Preferences, **Will print Policy Holders name if relationship is 'Child', Insured's or Authorized Person's Signature, Date of Current Illness, Injury, Pregnancy, If Patient Has Had Same or Similar Illness, Dates Patient Unable To Work In Current Occupation, Name of Referring Physician or Other Source, Hospitalization Dates Related To Current Services, Edit Service code | AMA Info | Diagnosis Code, Change Answers (button in Process Claims window. PDF Electronic Data Interchange - California medi-cal provider number. Box 15539 User Experience, Curve Dental, LLC The following test cases were updated on 09/08/2015: Notify Denti-Cal's EDI Support (denti-caledi@delta.org) that you intend to submit a batch of test claims. Blank ADA forms should be selected when printing on a blank piece of a paper. General Medi-Cal Dental program questions. 10745 Westside Way Send claims to: Denti-Cal California Medi-Cal Dental Program PO Box 15609 Sacramento CA 95852-0609 Q: Who will I receive . DHCS encourages non-Medi-Cal dental providers to enroll with Medi-Cal. Procedures, Services, or Supplies: CPT/HCPCS, Modifier. Edit the Employer that is attached as patients secondary. If this feature is needed, please contact us. In Claims, we have added a new link to the claims module (for those that have activated it). After obtaining approval from the State, Denti-Cal will provide Tumbleweed instructions (a secure email). The SSN pulls from the edit person screen OR the Id pulls from edit person | preferences on the Policy Holder. Community Health Group | Contact Member Services Department - chgsd.com PDF sni.l~ le Provider Bulletin - California Create and complete one procedure: a D0330 with fee 88. www.denti-cal.ca.gov Provider Bulletin, September 2019 | 7 . Manually enter two test patients into a blank Open Dental database as follows: Create the following fake procedures and claims for certification testing. Help in locating a Medi-Cal dental provider in your area. We are here to answer your questions or concerns. The 2006 ADA Dental Claim form was added in version 14 of Eaglesoft. Edit the Employer that is attached to the secondary policy holder. PDF An Advocate's Guide to Medi-Cal Services - National Health Law Program For test cases, use data from real patients and real insurance plans to make testing easier. Denti-Cal Provider Bulletins. If you are a DMC member and need information about our program, please visit the available links. Call toll-free 1-800-709-8348 in Contra Costa County or visit the Contra Costa Employment and Human . Policy Holders information listed in their edit person screen. The call is free. Complete the full testing phase by submitting test cases for certification. The primary insurance plan must be a non Denti-Cal plan with fake subscriber name and fake subscriber ID of 123456789. Submit one 837D claim transaction to Denti-Cal. In the Edit Claim window, under the General tab, type the following Claim Note: "Surface code test". suspected Medi-Cal Fraud. In the Edit Claim window, under the General tab, type the following Claim Note: "Share of Cost test". Type 2 NPI will print here if the preference under Lists | Practice Information | Identification | print Type 2 NPI on Insurance Claim is chosen. Once this test is successful, Denti-Cal will request a formal project from the State. 8:00 a.m. to 5:00 p.m., Monday through Friday to assist you. PDF Medi-Cal Dental Provider Bulletin - California You can also visit the Medi-Cal Dental website for billing procedures and updates. Medi-Cal dental program representatives are available 8:00 a.m. to 5:00 p.m., Monday through Friday to assist you. Eaglesoft provides ADA and Blank ADA form options. Health Net Medi-Cal Dental | Health Net 1031 Waterloo Rd., Stockton, CA 95205 83 W. March Lane, Stockton, CA 95207 (Weberstown) 2135 N. Tracy Blvd., Tracy, CA 95376 302 Northgate Dr., Manteca, CA 95336 SAN RAFAEL'S DENTAL CLINIC www.stmarysdiningroom.org 209-467-0774 Dental services for uninsured children and adults. Denti-Cal assigns a Document Control Number or "DCN" to the original preauthorization or "TAR" submitted. In the Edit Claim window, under the General tab, type the following Claim Note: "Multiple rendering providers test". This included an update to boxes 7 and 14 to allow the gender options of M, F, and U. Create and complete one procedure: a D1110 with fee 40. Create and complete one procedure: a D0270 with fee 100. P.O. Patients date of birth listed in their edit person screen. Ask for Denti-Cal EDI Support when you've reached an operator. Dental service fees based on income. Dental Benefit Plans - California Dental Association In the Edit Claim window, under the General tab, type the following Claim Note: "Claim Adjustment test". We are proud to present this integration, to encourage the efficiency of your office with regards to Denti-Cal claims. In the Treatment Plan module, select the D0150 and click the Preauthorization button to create a new Preauthorization claim. If an ADA form is selected and printed on a blank piece of paper the boxes for the form will not show. We also use phone interpreters to assist members in the following threshold languages and in more than 200 other . This link allows you to select a date that your RTD report would have been sent out from Denti-Cal. Last modified date: 3/23/2021 12:31 PM If you are considering joining Health Net's Medi-Cal dental plan as a new member and have any questions, please contact us at our toll free number, Monday through Friday, 7:30 a.m. to 7:00 p.m. 1-800-213-6991 Your Consumer Rights You have the right to get full and equal access to health care services covered by your health plan. There are also some minor changes to the section titled Ancillary Claim/Treatment Information (boxes 38-47); boxes 38-40, 43, and 45 have some modifications in respect to check boxes. If Denti-Cal is your primary clearinghouse, set Denti-Cal as the default in the E-Claims window. In their Edit Provider Screen | Identification | 'Use Practice Address on Insurance Forms' is NOT checked then it will print the address from the provider on insurance Edit Provider screen. TTY: 1-855-266-4584. Representation of all document types as applicable: Create and complete one procedure: a D2161 with fee 230. Claim Form Samples and Specifications *If ID Facility By is set to None, then ID Dentist By must have a selection. EDI Support Email: denti-caledi@delta.org. claim inquiry form. Complete the following steps to quickly and easily contact our offices. Click the Send E-Claims dropdown, then select Denti-Cal. Create a secondary claim for the D1120. This is the claim which Denti-Cal will see. For hearing impaired members: Please call 1-800-735-2922 for Teletext Typewriter (TTY) assistance. Denti-Cal will issue a Login ID (Remote ID) and password when a provider enters the full testing phase (step 4). Service office locations are identified using qualifier 'LU' in REF01 of Loop 2010BB." The report identifies requests for missing or additional information, and may be printed, completed, signed and returned to the carrier for processing. To contact the Medi-Cal Dental Program, please call the Member Telephone Service Center at (800) 322-6384. HCFA 1500 Medical Claim Form Specifications. In the General tab at the bottom, change the Accident Related dropdown to Other, set the Accident Date to today's date, set the Accident State to your state. ** Must have a Qualifier attached to the Provider Label to Print. According to Denti-Cal: "When a single NPI is registered with Denti-Cal for more than one service office, the NPI is considered non-subparted. Medi-Cal: Contact Medi-Cal Welcome to the Dental Managed Care (DMC) Members Web Page. Our Member Services team is available 24-hours a day seven day a week. Is Patient's Condition Related To: Employment? Will always display 'JP' - ADA's Universal/National Tooth, If entered on Treatment Plan (only for preauthorization), Entered on Treatment Plan (only for preauthorization). In the Edit Claim window, under the Misc tab, set the, In the Edit Claim window, under the General tab, type the following Claim Note: "NOA test". There are no suggestions because the search field is empty. PDF Medi-Cal Dental Provider Bulletin - California Click Send to send the claim file to the Claim Export Path set on the Edit Clearinghouse window (typically. Medi-Cal Dental Member Contact Information - California Medi-Cal Dental Dental Portal - California mailing address. Medi-Cal Fraud (800) 822-6222 stopmedicalfraud@dhcs.ca.gov. (Dental will always be checked). Allow us to better serve you by enabling a faster line of communication, receive notifications when information you care about is updated and customize your support interests. Edit the Insurance that is attached as patients secondary. *If ID Facility has a selection other than None, the box will pull from Lists | Practice Information | Information or Identification. Ready to see how Curve Hero can streamline, strengthen and secure your practice? Medi-Cal dental program representatives are available Alpharetta, Georgia 30009, Copyright 2023 CD Newco, LLC Create and complete one procedure: a D0272 with fee 130. Sometimes there are special needs that need to be addressed separately outside of the usual claims system. If your provider number is deactivated, you must reapply for enrollment in the Denti-Cal Program. How Do I Apply? Dental Managed Care Member Contact Info. PDF California Medi-Cal Dental Bullet CMS 1500 02/2012 Medical Claim Form Sample, Denti-Cal Combination Treatment Authorization Form (TAR)/Claim Form DC-217 Laser Format Sample, Employer Preferences SetupQuick Reference Sheet, Employer Preferences Setup - Quick Reference Sheet, Eaglesoft - Insurance Claim Form for Submitting Medical Claim Forms. Printed copies of this document are considered uncontrolled. Assign the provider as the default Provider. These forms can be found on the Denti-Cal website. EDI Support Phone: (916) 853-7373. Create a provider that is 'not a person' and for NPI enter the service facility's NPI. In the Edit Claim window, under the General tab, type the following Claim Note: "Quadrant code test". Curve Hero, In their Edit Provider Screen | Identification | Billing Entity License #, If Billing Entity License # is blank it will pull from the Provider on Insurance Edit Provider | Identification | License, Based on employer preferences for the Policy Holder 'Identify Billing Dentist By'. This preference will dictate where it should be entered under the Provider On Insurance selected in the Edit Provider screen for the Provider on Walkout, In their Edit Provider Screen | Identification. Medi-Cal Dental Provider Contact Info. This update addresses one of these special cases. Have other questions? If it is checked the Practice Address from Lists| Practice Information will print. It is the intent of DHCS and the FI to process claims as accurately, rapidly and efficiently as possible. Based on employer preferences | ID Policy Holder By. for clarification call denti-cal. Sign-up for the Denti-Cal Fee-For-Service Provider e-mail distribution list and receive the latest Medi-Cal Dental Program updates and announcements straight to your inbox. On the OSF, there is a section named EDI INPUT/OUTPUT OPTIONS. Create and complete one procedure: a D2140 with fee 135. CDA member-dentists can use their voice in two important ways to support dental plan reform and CDA's advocacy efforts this year: (1) Tell your legislator to support two CDA-sponsored bills that . Create and complete one procedure: a D6750 with fee 500 (Prosthesis Replacement set to initial). Dentical-DC-217.xml - use for versions 12.3.2 and earlier. If you are a DMC member and need information about our program, please visit the available links. Appeal Form (90-1) An appeal may be submitted using the Appeal Form (90-1). If printing forms, here are the downloads for the 2008 Denti-Cal claimform: For detailed steps on importing these files into Open Dental, see Claim Forms. PDF San Joaquin County Dental Resource Information - sjcphs.org Providers should contact the Telephone Service Center at 1-800-423-0507 or visit the Medi-Cal Dental website at www.dental.dhcs.ca.gov . Insurance Questions (popup when creating a claim form), Change Answers (button in Process Claims window), List | Service Codes | Edit Service Code being used, Total on Treatment Plan (only for preauthorization), Patients edit person screen Missing Tooth button, Change Answers (button in Process Claims window), Insurance Questions (popup when creating a claim form ), Change Answers (button in Process Claims window ), In Patients Edit Person screen under Preferences *, *Will print Policy Holders name if relationship is 'Child', Release Info on FileName will print in Box 36, No Release InfoName will not print in Box 36, Select 'Other' if you need child's name to appear in box, Based on employer preference for the Policy Holder | Estimate Insurance & Authorize Payment to Office must be checked. Dental Authorizations & Claims - DHCS Create a single claim with both procedures attached. This form isalmost identical to the 2006 form, other than the 2012 has new fields for Diagnosis Codes and Pointers. Fill out the Provider Service Office Electronic Data Interchange (OSF) form, EDI Enrollment Application, and Electronic Remittance Advice (ERA) form and submit to Denti-Cal. Denti-Cal website address EDI support Medi-Cal Dental Forms Timing of your payments There will be minimal changes, which you will receive additional information about in the near future. Edit the D0330. Create and complete one procedure: a D2160 with fee 210. *Diagnosis Codes or Nature of Illness or Injury. We have now added the ability for you to access these reports on . Policy Holders preferences in their edit person screen. Medi-Cal Dental Member Contact Info. For hearing impaired members: Please call 1-800-735-2922 for Teletext Typewriter (TTY) assistance.