At least one transaction that includes a Share of Cost amount. ** Type 2 NPI will print here if the preference under Lists | Practice Information | Identification | print Type 2 NPI on Insurance Claim is chosen. Dental Benefit Plans - California Dental Association We have now added the ability for you to access these reports on . 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). If it is checked the Practice Address from Lists| Practice Information will print. 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'. If this feature is needed, please contact us. Printed copies of this document are considered uncontrolled. The primary claim should not be sent. There is also an additional ERA Enrollment Form to address the 835 transaction. Employer preferences for the Policy Holder| ID Facility By, Billing Name, Address, Zip Code, & Phone Number, Employer preferences for the Policy Holder | ID Dentist By. In the Edit Claim window, under the General tab, type the following Claim Note: "Claim Adjustment test". Answer ID 2106 | Access: Everyone Review where information is pulled from in Eaglesoft to the ADA 2019, 2012, 2006, CMS 1500, HCFA 1500, Denti-Cal DC-217, and Denti-Cal DC-017A Insurance Claim Forms (Claim Form Specifications) Applies to: Eaglesoft Paper and eClaims Click the + or the header to expand the section for the specific claim form. Create and complete one procedure: a D6750 with fee 500 (Prosthesis Replacement set to initial). adams, james dds 1234567899. anytown, ca . Dental Authorizations & Claims - DHCS Continued on pg 4 . 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. During the testing phase, you can still use your existing clearinghouse (e.g. 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. Patient Portion from treatment plan (only for preauthorization), Estimated Insurance from treatment plan (only for preauthorization), Denti-Cal DC-017A Claim Form Specifications. If you are a DMC member and need information about our program, please visit the available links. We also use phone interpreters to assist members in the following threshold languages and in more than 200 other . To request an enrollment package, please contact the Denti-Cal Provider Customer Service line at (800)-423-0507, Procedures, Services, or Supplies: CPT/HCPCS, Modifier. RTD reports are set to not display by default. Once successful, Denti-Cal 's EDI Support will request a formal project from the State. Medi-Cal Dental Provider Contact Info. Create a claim for the procedure and send it. Only send the secondary Denti-Cal claim for testing purposes. **Will need to delete incorrect service and walkout the correct service code. ADA forms should be selected when using a pre-printed ADA form. 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. Medi-Cal Dental Program - DHCS 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. For hearing impaired members: Please call 1-800-735-2922 for Teletext Typewriter (TTY) assistance. No action is required on your part . Type 2 NPI will print here if the preference under Lists | Practice Information | Identification | print Type 2 NPI on Insurance Claim is chosen. 30 center street (xxx) xxx-xxxx. PDF sni.l~ le Provider Bulletin - California box 15609. sacramento, california 95852-0609. phone 800-423-0507. billing provider name. Subscriber Name, Address, City, State, Zip Code. When a claim needs to be re-submitted, Denti-Cal sends back an electronic report called aResubmission Turnaround Document (RTD). www.denti-cal.ca.gov Provider Bulletin, September 2019 | 7 . Pharmacy Benefits and Vision Benefits P.O. Ready to see how Curve Hero can streamline, strengthen and secure your practice? CALIFORNIA MEDI-CAL DENTAL PROGRAM - Denti-Cal - State of - Yumpu Use this information to set up the Denti-Cal clearinghouse. Call toll-free 1-800-709-8348 in Contra Costa County or visit the Contra Costa Employment and Human . 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. Costs for Medi-Cal services vary. Edit the Employer that is attached to the policy holder. In the Edit Claim window, under the General tab, type the following Claim Note: "Employment-related accident test". Set the date for the D0120 to today's date, and set the date for the D1351 to yesterday's date. ClaimConnect) to submit claims. Service office locations are identified using qualifier 'LU' in REF01 of Loop 2010BB." Change the treating provider on the D0140 so it is different than the treating provider for the D0272 (based on NPI). The report identifies requests for missing or additional information, and may be printed, completed, signed and returned to the carrier for processing. 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. The SSN pulls from the edit person screen OR the Id pulls from edit person | preferences on the Policy Holder. 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. Alpharetta, Georgia 30009, Copyright 2023 CD Newco, LLC To obtain a listing of Denti-Cal providers, call 1-800-322-6384 or visit the main Denti-Cal website. Medi-Cal Dental Program - Members - Dental Managed Care - California 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 generally does not involve Open Dental. Your file is uploaded and ready to be published. 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. 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. Box 997413, MS 4604 Representation of all document types as applicable: Create and complete one procedure: a D2161 with fee 230. 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. claim inquiry form. Assign the provider as the default Provider. Create and complete one procedure: a D1351 with fee 130. Medi-Cal dental program representatives are available 8:00 a.m. to 5:00 p.m., Monday through Friday to assist you. 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. Edit the Insurance that is attached to the secondary policy holder. We are here to answer your questions or concerns. PDF Medi-Cal Dental Provider Bulletin - California For at least one procedure assign the site (. CDA member-dentists: Join our efforts to hold dental benefit plans accountable and improve dental plan coverage. Is Patient's Condition Related To: Auto Accident? Secondary Policy Holders gender listed in their edit person screen. Occasionally (like in June-October of 2019) Denti-Cal requires communication testing when they make changes to their system. city, state. Patients information listed in their edit person screen. The SSN pulls from the edit person screen OR the Id pulls from edit person | preferences on the Policy Holder. In the Treatment Plan module, select the D0150 and click the Preauthorization button to create a new Preauthorization claim. . Any pending input will be lost. Edit Insurance Company OR select Change Ins in process claims window to change. Offices may submit claims directly to Denti-Cal using the process outlined below. 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. Dental service fees based on income. Create and complete one procedure: a D1120 with fee 58. Walkout checks Statement of Actual Services box, Treatment Plan checks Request for Predetermination box, Insurance Questions (popup when creating a claim form), Change Answers (button in Process Claims window), Carrier Name, Address, City, State, Zip Code, Insurance Company Attached to Policy Holders Employer. 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 . In their Edit Provider Screen | Identification | National Provider. Denti-Cal website address EDI support Medi-Cal Dental Forms Policy Holders date of birth listed in their edit person screen. The share of cost in this example is 18. Address, City, State, Zip Code (Location of Treatment). The ADA2012 Dental claim form is included in Eaglesoft 17. The ADA2019 Dental claim form is included in Eaglesoft 21.00.18. Patients date of birth listed in their edit person screen. Other Carrier Name, Address, City, State, Zip Code. In the Edit Claim window, under the General tab, type the following Claim Note: "Quadrant code test". These forms can be found on the Denti-Cal website. for clarification call denti-cal. In the Edit Claim window, under the General tab, type the following Claim Note: "Other Health Coverage test". April 26, 2023 Medi-Cal/Denti-Cal. We realize you may not need this ability as you may not interact with Denti-Cal. california medi-cal dental program. You can find the DCN on the approval notice or "NOA" that was sent by Denti-Cal. 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 *Diagnosis Codes or Nature of Illness or Injury. Is Patient's Condition Related To: Other Accident? Larger offices may want to submit directly to Denti-Cal, because there is a fee per claim when using a clearinghouse. When this is done, the steps below are not needed. 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. Based on employer preferences for the Policy Holder, ID Facility By and ID Dentist By are both considered when Box 52a is populated. In the Edit Claim window, under the General tab, type the following Claim Note: "Claim test". Edit the Insurance that is attached as patients secondary. EDI Support Email: denti-caledi@delta.org. Based on employer preferences, the SSN pulls from the edit person screen OR the Id pulls from edit person | preferences. In the Edit Claim window, under the General tab, type the following Claim Note: "Multiple rendering providers test". Create and complete one procedure: a D0120 with fee 60. For more information about your dental managed care plan choices, please visit Health Care Options, Medi-Cal Dental Billing for Services Who can a provider contact with a question regarding billing and claims information? Click the Send E-Claims dropdown, then select Denti-Cal. In the Main Menu, click Setup, Family/Insurance, Clearinghouse, then double-click on Denti-Cal. TTY: 1-855-266-4584. Medi-Cal: Contact Medi-Cal Clinical screening appointment information. Edit Patient | Preferences | Student Status, different fields compared to the HCFA 1500, CMS 1500 Medical Claim Form Specifications. This form isalmost identical to the 2006 form, other than the 2012 has new fields for Diagnosis Codes and Pointers. Create and complete one procedure: a D1110 with fee 40. Only applies if patient has Secondary Insurance. Contact | Delta Dental We have now added the ability for you to access these reports on-demand through Curve Hero. Patient 2: Two insurance plans. 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. The claims used for testing should be fake claims, because they will not be adjudicated. Most Denti-Cal users submit claims to a clearinghouse, which then submits to Denti-Cal. If Denti-Cal is not your primary clearinghouse, enter each Insurance Plan's Payor ID in the Edit Clearinghouse window. DHCS encourages non-Medi-Cal dental providers to enroll with Medi-Cal. *This will only populate when the Provider on Claim differs from the Provider in box 33a and 33b. PDF California Medi-Cal Dental Bullet In the bottom left of the Procedure Info window, type "test note" into the E-claim Note. PDF Appeal Form Completion (appeal form) - Medi-Cal Medi-Cal :: Contra Costa Health Services :: Contra Costa Health In the Edit Claim window, under the General tab, type the following Claim Note: "Arch code test". Conditions of Use; Privacy Policy; Nondiscrimination Policy; Accessibility; Accessibility Certificate 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 . . 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. In their Edit Provider Screen | Identification |Specialty field, Based on employer preference for the Policy Holder | 'ID Treating Dentist By'. How Much Does It Cost? Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software. It is the intent of DHCS and the FI to process claims as accurately, rapidly and efficiently as possible. Denti-Cal Claims & Resubmission Turnaround Document Protocol - Curve Dental Will always display 'JP' - ADA's Universal/National Tooth, If entered on Treatment Plan (only for preauthorization), Entered on Treatment Plan (only for preauthorization). Claim Form Samples and Specifications Based on employer preferences | ID Policy Holder By. In their Edit Provider Screen | Identification | Medicaid ID. Create and complete one procedure: a D2940 with fee 90. Medi-Cal covers dental services that are provided through Denti-Cal. ALL RIGHTS RESERVED. The Billing address is always pulled from Lists | Practice, In their Edit Provider Screen | Identification | National Provider Identification. Secondary Policy Holders date of birth listed in their edit person screen. This is a replacement of the Laser Claim Form (DC-017A) and TAR (DC-017B) and is requiredfor paper claims by April 1, 2008. In the Edit Claim window, under the Attachments tab, type "1" in the Radiographs textbox. 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. At least one transaction reflecting an employment-related accident. The 2006 ADA Dental Claim form was added in version 14 of Eaglesoft. If your provider number is deactivated, you must reapply for enrollment in the Denti-Cal Program. Edit the Employer that is attached to the secondary policy holder. Is Patient's Condition Related To: Employment? CommuniCare Advantage (HMO SNP) (HMO D-SNP): 1-888-244-4430. Denti-Cal Combination TAR/Claim Form DC-217 Specifications. PDF California Medi-Cal Dental Bullet Curve Hero, In the Edit Claim window, under the General tab, type the following Claim Note: "Share of Cost test". In the Edit Claim window, under the General tab, type the following Claim Note: "x-ray and other attachment test". Medi-Cal Dental Member Contact Info. telephone number. General Medi-Cal Dental program questions. Ask for Denti-Cal EDI Support when you've reached an operator. There are no suggestions because the search field is empty. At least one transaction that includes a service description. 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. Create and complete one procedure: a D0140 with fee 57. If an ADA form is selected and printed on a blank piece of paper the boxes for the form will not show. For test cases, use data from real patients and real insurance plans to make testing easier. At least one transaction that includes an Other Health Coverage amount. 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. To send the service facility information (site place of service, address and NPI), follow these steps. Our Member Services team is available 24-hours a day seven day a week. denti-cal. Make sure to change the Comm Bridge back to Denti-Cal. This update addresses one of these special cases. Note: Anyone wishing to test Dentical claims will need to set the ISA15 field in the clearinghouse setup to T to enable testing mode. A brief description of claims processing methods follows. Based on employer preferences | ID Policy Holder By. Edit Employer | Preferences | ID Dentist By. p.o. Edit the Insurance that is attached to the policy holder. Eaglesoft provides ADA and Blank ADA form options. Medi-Cal: 1-800-224-7766. Reporting, The report identifies requests for missing or additional information, and may be printed, completed, signed and returned to the carrier for processing. Patient Name, Address, City, State, Zip Code. In the Edit Claim window, under the General tab, type the following Claim Note: "Tooth code test". Open Dental does not currently handle sub-parted NPIs for Denti-Cal. You can also visit the Medi-Cal Dental website for billing procedures and updates. Create a single claim with both procedures attached. 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