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Medi-Cal Dental Provider Handbook (Handbook)

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October 2021 Dear Medi-Cal Dental Provider: Enclosed is the most recent update of the Medi-Cal Dental Provider Handbook (Handbook). The pages reflect changes made to the Medi-Cal Dental Program during the month of October 2021. These changes are indicated with a vertical line next to the text. The following list indicates the pages that have been updated for this month’s Handbook release. The latest version of the Handbook can be found on the Medi-Cal Dental website Provider Handbook page. Handbook Updates Section 1 – Introduction 1-2 Section 2 – Program Overview 2-1, 2-12, 2-26 Section 3 – Enrollment Requirements 3-1, 3-3, 3-9 Section 4 – Treating Members 4-12 Section 9 – Special Programs 9-4 Section 10 – CDT 21 Tables All Section 11 – Glossary 11-1 Section 12 – Bulletin Index 12-2 Thank you for your continual support of the Medi-Cal Dental Program. If you have any questions, please call (800) 423-0507. Sincerely, MEDI-CAL DENTAL CALIFORNIA MEDI-CAL DENTAL PROGRAM October 2021 Dear Doctor: We are pleased to provide you with the Medi-Cal Dental Provider Handbook (Handbook). The purpose of this Handbook is to give dental care professionals and their staff a concise explanation of billing instructions and procedures under the California Medi-Cal Dental Program. It is designed to assist you in your continued participation in Medi-Cal Dental. We trust you will find the Handbook useful and that it will be maintained as a working document. Please do not hesitate to visit the Medi-Cal Dental website for further assistance. Sincerely, Alani Jackson, MPA Division Chief Medi-Cal Dental Services Division Department of Health Care Services Alisha Hightower, Executive Director Government Programs California Medi-Cal Dental Program Delta Dental of California P.O. Box 15609 • Sacramento, CA 95852-0609 • (800) 423-0507 • (916) 853-7373 Preface This Handbook contains basic information about Med-Cal Dental. It is designed to provide detailed information concerning Medi-Cal Dental policies, procedures, and instructions for completing the necessary forms and other related documents. The criteria and policies contained in this Handbook are subject to the provisions of the Welfare and Institutions (W & I) Code and regulations under California Code of Regulations (CCR), Title 22. When changes in these criteria and/or policies occur, bulletins and revised pages will be issued for purposes of updating the information in this Handbook. Please call the Medi-Cal Dental Telephone Service Center toll-free at (800) 423-0507 with any questions you have regarding the contents of this Handbook or participation in the California Medi-Cal Dental Program. Our Provider Services staff will be happy to assist you. This Handbook, and other valuable information, can be found on the Medi-Cal Dental website. How to Use This Handbook This Handbook is your primary reference for information about Medi-Cal Dental, as well as submission and processing of all necessary documents. The Handbook contains detailed instructions for completing Medi-Cal dental claims, Treatment Authorization Requests, Resubmission Turnaround Documents, Claim Inquiry Forms, and other billing forms for dental services and should be consulted before seeking other sources of information. The Handbook is organized into 13 major sections: • Section 1 - Introduction • Section 2 - Program Overview • Section 3 - Enrollment Requirements • Section 4 - Treating Members • Section 5 - Manual of Criteria and Schedule of Maximum Allowances • Section 6 - Forms • Section 7 - Codes • Section 8 - Fraud, Abuse, and Quality of Care • Section 9 - Special Programs • Section 10 - CDT 19 Tables • Section 11 - Glossary • Section 12 - Bulletin Index • Section 13 - Index The Table of Contents provides an overview of all major sections and subsections in the Handbook. Bulletin information released from December 2020 through October 2021 has been incorporated into the Handbook. Please refer to the Bulletin Index for the page where the information may be found. Table of Contents Introduction ................................................................................... 1-2 Program Background ................................................................................................................................................. 1-2 Program Objectives ................................................................................................................................................... 1-2 Regulations ................................................................................................................................................................ 1-2 Current Dental Terminology (CDT) Copyright ............................................................................................................ 1-2 Program Overview .......................................................................... 2-1 Provider Participation in the California Medi-Cal Dental Program ............................................................................ 2-1 Compliance in Medi-Cal Dental ................................................................................................................................. 2-1 Out-of-State Coverage ............................................................................................................................................... 2-2 Written Correspondence ........................................................................................................................................... 2-2 Suspended and Ineligible Providers ........................................................................................................................... 2-3 Enrollment Denied for Failure to Disclose Fraud or Abuse, or Failure to Remediate Deficiencies ........................... 2-3 General Telephone Information ................................................................................................................................ 2-4 Provider Toll-Free Telephone Number .................................................................................................................. 2-4 Member Toll-Free Telephone Number ................................................................................................................. 2-4 Contact Listings for Medi-Cal Dental ......................................................................................................................... 2-5 Internet Access and Websites ................................................................................................................................... 2-6 Email ...................................................................................................................................................................... 2-6 Training Program ....................................................................................................................................................... 2-7 Seminars ................................................................................................................................................................ 2-7 On-Site Visits ......................................................................................................................................................... 2-7 Provider Appeals Process .......................................................................................................................................... 2-8 Provider First-Level Appeals .................................................................................................................................. 2-8 Health Insurance Portability and Accountability Act (HIPAA) and the National Provider Identifier (NPI) ................ 2-9 Registering NPIs ..................................................................................................................................................... 2-9 Freedom of Information Act (FOIA)-Disclosable Data ............................................................................................... 2-9 Electronic Data Interchange (EDI) ............................................................................................................................ 2-10 Digitized Images .................................................................................................................................................. 2-10 Overview of TAR and Claim Processing ................................................................................................................... 2-11 Document Control Number (DCN) ...................................................................................................................... 2-11 Edits and Audits ....................................................................................................................................................... 2-11 TAR/Claim Adjudication ...................................................................................................................................... 2-11 Radiographs ......................................................................................................................................................... 2-11 Prior Authorization .................................................................................................................................................. 2-12 Election of Prior Authorization ...........................................................................................................................
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