Questions regarding your Treatment Authorization Request (TAR). Policy Holders gender listed in their edit person screen. For test cases, use data from real patients and real insurance plans to make testing easier. Once successful, Denti-Cal 's EDI Support will request a formal project from the State. adams, james dds 1234567899. anytown, ca . 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. Is Patient's Condition Related To: Auto Accident? The primary claim should not be sent. 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. At least one transaction that includes a Share of Cost amount. The Handbook is designed for Denti-Cal accepting providers and their staff as their primary reference for information about the Denti-Cal Program, and can also be a helpful tool for advocates.19 ADVOCACY TIP: 3 It is critical to ensure that Medi-Cal accepting dental providers bill Medi-Cal for covered dental services. If your provider number is deactivated, you must reapply for enrollment in the Denti-Cal Program. ** Must have a Qualifier attached to the Provider Label to Print. At least one transaction reflecting an employment-related accident. The ADA2012 Dental claim form is included in Eaglesoft 17. You can also visit the Medi-Cal Dental website for billing procedures and updates. Patient Name, Address, City, State, Zip Code. California Medi-Cal Dental Program
The claims used for testing should be fake claims, because they will not be adjudicated. In the Edit Claim window, under the General tab, type the following Claim Note: "x-ray and other attachment test". Policy Holders preferences in their edit person screen. Larger offices may want to submit directly to Denti-Cal, because there is a fee per claim when using a clearinghouse. Curve Hero, In the Main Menu, click Setup, Family/Insurance, Clearinghouse, then double-click on Denti-Cal. PDF San Joaquin County Dental Resource Information - sjcphs.org please contact the Telephone Service Center at (800) 423-0507. Create and complete one procedure: a D0270 with fee 100. Secondary Policy Holders date of birth listed in their edit person screen. There is also an additional ERA Enrollment Form to address the 835 transaction. Note: Anyone wishing to test Dentical claims will need to set the ISA15 field in the clearinghouse setup to T to enable testing mode. Set the date for the D0120 to today's date, and set the date for the D1351 to yesterday's date. Patients information listed in their edit person screen. In the Edit Claim window, under the General tab, type the following Claim Note: "Claim test". Back to top. In the Edit Claim window, under the General tab, type the following Claim Note: "Tooth code test". In their Edit Provider Screen | Identification |Specialty field, Based on employer preference for the Policy Holder | 'ID Treating Dentist By'. 2018 Patterson Dental Supply, Inc. All rights reserved. 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. Medi-Cal dental program representatives are available
If you are a DMC member and need information about our program, please visit the available links. So, if you need this ability you willneed to configure this setting with a simple click of the mouse in the Insurance Management section of Administration. Create a provider that is 'not a person' and for NPI enter the service facility's NPI. This is a replacement of the Laser Claim Form (DC-017A) and TAR (DC-017B) and is requiredfor paper claims by April 1, 2008. 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. These reports are available electronically from the carrier via our clearing house, and allow you to identify requests for missing or additional information from the carrier on submitted Denti-Cal claims. Telephone Service Center (TSC): 1-800-541-5555 Automated Phone Center: 1-800-786-4346 Out-of-State Provider Support: 1-916-636-1960 Small Provider Billing Assistance: 1-916-636-1275 Correspondence Billing Correspondence Cash Control Correspondence Medi-Cal Beneficiaries Claim Form Samples and Specifications Only applies if patient has Secondary Insurance. In the Edit Claim window, under the Attachments tab, set the Attachment ID Number to "NEA#1234567". For at least one procedure assign the site (. version of the TAR/Claim form when submitting to Medi-Cal Dental. Create and complete one procedure: a D1110 with fee 40. Is Patient's Condition Related To: Employment? To obtain a listing of Denti-Cal providers, call 1-800-322-6384 or visit the main Denti-Cal website. Your file is uploaded and ready to be published. Medi-Cal Dental Member Contact Information - California Appeal Form (90-1) An appeal may be submitted using the Appeal Form (90-1). Edit the Insurance that is attached to the policy holder. Edit Patient | Has Insurance | Relationship. 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'. 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. The Open Dental X12 file format is certified by Denti-Cal, however each dental office that wishes to submit directly must also go through their own certification testing with Denti-Cal. Change the treating provider on the D0140 so it is different than the treating provider for the D0272 (based on NPI). CHDP Child Health and Disability Prevention? Medi-Cal Dental Program - DHCS In the Edit Claim window, under the General tab, type the following Claim Note: "Non employment-related accident test". Note: If a Service Office Number must be sent in order to supplement an NPI, then enter that number at the bottom of the. 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. 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. Call toll-free 1-800-709-8348 in Contra Costa County or visit the Contra Costa Employment and Human . To send the service facility information (site place of service, address and NPI), follow these steps. Denti-Cal assigns a Document Control Number or "DCN" to the original preauthorization or "TAR" submitted. Is Patient's Condition Related To: Other Accident? RTD reports are set to not display by default. General Medi-Cal Dental program questions. When you connect with the Medi-Cal Dental Interactive Voice Response System (IVR) you may select from the following menu options: You may call the automated IVR to obtain general information which includes information on covered benefits, how to file a Fair Hearing, requesting copies of your dental records, and reporting
Patients date of birth listed in their edit person screen. This update addresses one of these special cases. 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". This allows you to retrieve past data on each of the daily reports. Medi-Cal and Medi-Cal Dental Contacts - DHCS The Remote ID starts with the letters DC. Create and complete one procedure: a D1351 with fee 130. In the Edit Claim window, under the General tab, type the following Claim Note: "Multiple rendering providers test". This link allows you to select a date that your RTD report would have been sent out from Denti-Cal. Click the Send E-Claims dropdown, then select Denti-Cal. You can find the DCN on the approval notice or "NOA" that was sent by Denti-Cal. 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. 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 . In the Edit Claim window, under the General tab, type the following Claim Note: "Multiple dates of service test". PDF sni.l~ le Provider Bulletin - California medi-cal provider number. In the Edit Claim window, under the General tab, type the following Claim Note: "Service description test". Create and complete one procedure: a D5110 with fee 1130 (Prosthesis Replacement set to initial). 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. Please have the operator call the Toll-Free Member Line at 1-800-322-6384. The SSN pulls from the edit person screen OR the Id pulls from edit person | preferences on the Policy Holder. No action is required on your part . When this is done, the steps below are not needed. The report identifies requests for missing or additional information, and may be printed, completed, signed and returned to the carrier for processing. Medi-Cal Dental Dental Portal - California Edit the Employer that is attached to the policy holder. April 26, 2023 Medi-Cal/Denti-Cal. How Do I Apply? This is the claim which Denti-Cal will see. CALIFORNIA MEDI-CAL DENTAL PROGRAM - Denti-Cal - State of - Yumpu Dental Authorizations & Claims - DHCS In the Edit Claim window, under the General tab, type the following Claim Note: "Surface code test". Registration is quick and easy! To submit claims directly to Denti-Cal, you can print a paper Claim Form, or submit electronic claims. Edit the claim. Most Denti-Cal users submit claims to a clearinghouse, which then submits to Denti-Cal. . Based on employer preferences | ID Policy Holder By. If it is checked the Practice Phone Number from Lists| Practice Information will print. Complete the following steps to quickly and easily contact our offices. Alpharetta, Georgia 30009, Copyright 2023 CD Newco, LLC Representation of all document types as applicable: Create and complete one procedure: a D2161 with fee 230. 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). PDF An Advocate's Guide to Medi-Cal Services - National Health Law Program Medi-Cal: 1-800-224-7766. Dental service fees based on income. In the Edit Claim window, under the General tab, type the following Claim Note: "Claim Adjustment test". Medi-Cal :: Contra Costa Health Services :: Contra Costa Health 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. Medi-Cal Dental Provider Contact Info. Patients Social Security Number listed in their edit person screen. Clinical screening appointment information. We are proud to present this integration, to encourage the efficiency of your office with regards to Denti-Cal claims. Please have the operator call the Toll-Free Member Line at 1-800-322-6384. The Billing address is always pulled from Lists | Practice, In their Edit Provider Screen | Identification | National Provider Identification. Create a treatment planned procedure: a D0150 with fee 20. EDI Support Email: denti-caledi@delta.org. The report will load into a new browser tab for perusal. . A sample completed Appeal Form (see Figure 1) and detailed instructions are on a following page. Denti-Cal website address EDI support Medi-Cal Dental Forms