The medical program currently offers dental services as one of the programs many benefits. The comprehensive perinatal services program cpsp provides a wide range of culturally competent services to medical pregnant women, from conception through 60 days postpartum. Conversely, the dental service may be part of the medical dental program scope of benefits for adult members but not for members under the age of 21, or the dental provider may want to provide the service at a frequency or periodicity greater than currently allowed by the medical dental program. It is also provided to you in adobe acrobat reader. Sacramento medi cal gmc dental managed care liberty dental plan of california, inc. Providers seeking enrollment in the dentical program to be eligible for reimbursement for services provided to medical recipients must submit a complete application package, specific to their provider type. California department of health care services weaknesses.
If you are a dentical ffs beneficiary and need information about our program, please visit the helpful links below for hearing impaired beneficiaries. State law change renamed the access for infants and mothers program to the medical access program as of july 1, 2014. Oct 22, 2019 the medi cal dental program covers a variety of dental services for medi cal beneficiaries, such as. It is not meant to replace the detailed information in the medi cal dental program provider handbook provider handbook. For a full list of medical plans, go to the medical managed care medical plan directory for a full list of dental plans, go to the medical managed care dental plan directory.
Except as noted, the policies, procedures and programs described in this manual are applicable to all health net medical participating dental providers. Reason code 1 tooth does not meet the manual of criteria for a laboratory processed crown. Compare medical plans and dental plans medical managed. This is a summary of key information and requirements of the denti cal program. The department is committed to working with dental providers to improve the care provided to recipients. Refer to restorative general policies d2000 d2999 in section 5 of the provider handbook. Providers must be licensed and accredited according to the specific laws and regulations that apply to their service provider type.
Visit the dentical website to view provider enrollment requirements in the. If you have any questions, please call our provider tollfree line at 8004230507. Comprehensive perinatal services program delivering cpsp to. For a full list of medical plans, go to the medical managed care medical plan directory. Iehp medical member services 800 4404347 800 7184347 tty iehp dualchoice member services 877 2734347 800 7184347 tty iehp 24hour nurse advice line for iehp members only. Liberty has been providing dental services for the sacramento geographic managed care gmc program since 2005 and currently serves approximately 500,000 medi cal members in california. The dentical handbook is provided to you in a table of contents format. Dental plan benefits medical managed care health care options. I am medi cal contracted provider, will medi cal cover teledentistry. If your patient is a member of upmc health plan, this coverage only applies to the emergency dental. Dentists should familiarize themselves with the contents of the provider handbook and visit the denti cal program website frequently. You will need to provide your medical benefits identification card bic to your dental provider to receive dental services.
See a medical dental provider to get covered services that you need see your medical dental provider on a regular basis, even if you dont have a problem with your teeth. Reason code 128 cast and prefabricated posts are benefits in endodontically treated devitalized permanent teeth only when crowns have been authorized andor paid by the dentical program. You can then choose the primary dentist for your dental care needs. Medi cal dental providers this is a summary of key information and requirements of the medi cal dental program. Medical has coveragereimbursement information and reporting requirements within their current copy of the medical dental program provider handbook. The california medical dental program provider handbook, also known as the dentical handbook is updated with the information from the dentical bulletins each quarter. After you join a dental plan, you will get most of your medi cal benefits through that dental plan. Dental services provided in the medical assistance program. Clinicprogram contact each provider must identify an individual who will serve as the primary contact for rwpcp services and issues.
The medical dental provider handbook has been developed to assist the provider and office staff with participation in the medical dental program. Hints, tips, and reminders for document and radiograph submissions. Failure to comply with denti cal program requirements will result in corrective action. Medical dental program beneficiaries medical dental. We hope that you will benefit from the information presented at todaysseminar. After you join a dental plan, you will get most of your medical benefits through that dental plan. Overview of the dental transformation initiative dti american sign language asl translation services available for dentical beneficiaries. Your managed care dental plan should send you a provider handbook.
Adult dental benefits fully restored adult optional dental benefits. Claim submission dentical claims claims for inpatient and outpatient dental procedures are billed to dentical. Under the guidance of the california department of health care services, the medical dental program aims to provide medical beneficiaries with access to highquality dental care. Under the guidance of the california department of health care services, the medical feeforservice program aims to provide health care services to more than million medical beneficiaries. Members can access dental services through medical dental enrolled providers, who will advise members on the best. Medical dental providers this is a summary of key information and requirements of the medical dental program. Ncqa is a notforprofit organization dedicated to improving health care quality.
The denti cal handbook is provided to you in a table of contents format. If you are a denti cal ffs beneficiary and need information about our program, please visit the helpful links below for hearing impaired beneficiaries. Overview of the dental transformation initiative dti american sign language asl translation services available for denti cal beneficiaries. Jan 01, 2018 the full dental benefits are listed in the dental provider handbook, section 5, manual of criteria, posted on the medi cal dental website. Dental plan benefits medical managed care health care. Denti cal recipient eligibility providers should refer to the denti cal handbook for eligibility and. Anthem blue cross and blue cross of california partnership plan, inc. Medical wants you and your family to be healthy and satisfied with your dental care.
Covid19 temporary emergency provider enrollment in the medi cal dental program updated request for providers to notify medi cal dental of office closures during covid19 publication date april 2020 tags. You can get the most from your medical dental benefts when you. This chart below is to help you understand what services are provided by san francisco health plan sfhp. The dentical program has been administered by delta dental since 1974. Medi cal has coveragereimbursement information and reporting requirements within their current copy of the medi cal dental program provider handbook. Providers must be licensed and accredited according to the specific laws and regulations that apply to their serviceprovider type. The medical dental program covers a variety of dental services for medical beneficiaries, such as. Medical dental program providers provider handbook. The feeforservice dental portion of the medi cal program is known. For questions, please contact the dentical provider customer service line at 800 4230507. This document does not replace the detailed information in the medical dental provider handbook. If you are interested in becoming a dentical ffs provider, please contact the provider telephone service center at 18004230507.
As a reminder, section 2 program overview of the provider handbook contains information on provider participation and compliance in the dentical program. To learn more about dental plan benefits, read the information below medical managed care dental plan. Medical member through the dental practice above all. The feeforservice dental portion of the medical program is known as dentical. Jan 27, 2020 bulletins and manuals navigation tool. Medical dental member handbook pdf common dental terms common questions. Documentation for dental services should be consistent with the standards set forth in the manual of criteria for medical authorization of the medical dental program provider handbook and all state laws. Provider handbook type of benefits share of cost soc aid codes 9 not everyone receiving medi cal has fullscope benefits limited services restricted services emergency only services denti cal california medi cal dental program p. Please select a dental service plan that meets your needs.
Provider handbook type of benefits share of cost soc aid codes 9 not everyone receiving medical has fullscope benefits limited services restricted services emergency only services denti cal california medical dental program p. These changes are indicated with a vertical line next to the text. The california medical dental program provider handbook, also known as the dentical handbook is updated with the information from the. Please call dentical at 800 3226384 for dentalrelated coverage and service questions. Liberty provides access to one of the largest networks of independent dentists to provide quality dental care for sacramento. Liberty has been providing dental services for the sacramento. Sincerely, dentical galkomia medigal dental program provider enrollment enclosures. More information is available on the dhcs medi cal dental program website. Health net dental plan maintains a fast, fair, cost effective hipaa provider dispute resolution. Arabic armenian cambodian chinese english farsi hindi hmong japanese korean lao punjabi. Medical benefits and coverage san francisco health plan. Resource library dental benefit plans carrier specific. This is a summary of key information and requirements of the dentical program. Child beneficiaries can receive dental services from centers and clinics that include federally qualified health centers, rural health clinics, and indian health service clinics.
The treating provider must be enrolled as a medical dental provider. Box 15610 sacramento, california 95852 0610 treatment authorization request tar claim phone 800 423 0507. Feb, 2020 should also refer to the medical dental program provider handbook, located on the medical dental program website at ntical. Additional information is also found in section 8 fraud, abuse and quality of care. The cpsp provider handbook could not exist without the efforts of many dedicated individuals and organizations since the first edition was published in 1999. Members can access dental services through medi cal dental enrolled providers, who will advise members on the best. The denti cal program has been administered by delta dental since 1974. You may view this member handbook before enrollment in the medical program. Liberty has been providing dental services for the sacramento geographic managed care gmc program since 2005 and currently serves over 500,000 medical members in california. Medi cal wants you and your family to be healthy and satisfied with your dental care. More information is available on the dhcs medical dental program website.
It is not meant to replace the detailed information in the medical dental program provider handbook provider handbook. The medical program was established in 1965 to provide the necessary health services for. It is a public health insurance program administered by the california department of health care services dhcs. In addition to standard obstetric services, women receive enhanced services in the areas of nutrition, psychosocial and health education. Also known as the california medical dental program provider handbook. Failure to comply with dentical program requirements will result in corrective action. Dentists should familiarize themselves with the contents of the provider handbook and visit the dentical program website frequently. Please call 18007352922 for teletext typewriter tty assistance. Medi cal offers comprehensive preventative and restorative dental benefits to both children and adults you can find a medi cal dentist on the denti cal provider referral list, or by calling 18003226384. Dental care provider information pa department of human services.
Through the rwpcp application process, individuals are screened for other health care payers including medical. California medical dental program dentical medical offers free or lowcost health care for eligible california residents including dental benefits. Acupuncture acu audiology and hearing aids aud chiropractic chr durable medical equipment and medical supplies dme medical transportation mtr orthotics and prosthetics oap psychological services psy. Medical dental application package dhcs 5300 overview. To learn more about dental plan benefits, read the information below. View the california medi cal dental program provider handbook denti cal. The pages reflect changes made to the denti cal program during the month of may 2015. If you have any questions regarding the medical access program handbook or on the information contained on this page, please call the medical access program at 18004332611 tty 18007352929.
The pages reflect changes made to the dentical program during the month of may 2015. Covid19 temporary emergency provider enrollment in the medical dental program updated request for providers to notify medical dental of office closures during covid19 publication date april 2020 tags. Enclosed is the most recent update of the medical dental program provider handbook handbook. Dental benefits are provided through medical, also known as dentical. This section describes the dentical claim submission and authorization requirements for inpatient and outpatient services. Medi cal member through the dental practice above all. Reason code 081 periodontal procedures cannot be justified on the basis of pocket depth, bone loss, andor degree of deposits as evidenced by the submitted radiographs andor charting.
Refer to restorative general policies d2000 d2999 in section 5. Comprehensive perinatal services program delivering cpsp. Also known as the california medi cal dental program provider handbook, it is updated with the information from the denti cal bulletins each quarter. Providers seeking enrollment in the denti cal program to be eligible for reimbursement for services provided to medi cal recipients must submit a complete application package, specific to their provider type. Dentical recipient eligibility providers should refer to the dentical handbook for eligibility and. Medical member handbook evidence of coverage mar 30, 2018, 15. Pdr mechanism for contracted and noncontracted providers. Medical claims claims for inpatient hospital services and outp. The feeforservice dental portion of the medi cal program is known as denti cal. Medical dental program providers medical dental epsdt. Medical offers comprehensive preventative and restorative dental benefits to both children and adults you can find a medical dentist on the dentical provider referral list, or by calling 18003226384.
Visit dentical at the california dental association convention cda presents in san francisco 2016. The treating provider must be enrolled as a medi cal dental provider. As a reminder, section 2 program overview of the provider handbook contains information on provider participation and compliance in the denti cal program. State department that administers the medical access program the managed risk medical insurance board was closed on july 1, 2014 and the medical access. Enclosed is the most recent update of the medi cal dental program provider handbook handbook. Staff from the department of health care services, and the medical fiscal intermediary provided information on medical eligibility and billing and medical managed care. The full dental benefits are listed in the dental provider handbook, section 5, manual of criteria, posted on the medical dental website. To receive notice when this handbook is updated, each provider is required to provide the hshb contract administrator a program contact, including name, position or. Updated manual replacement pages will be published in a future medical update. Conversely, the dental service may be part of the medi cal dental program scope of benefits for adult members but not for members under the age of 21, or the dental provider may want to provide the service at a frequency or periodicity greater than currently allowed by the medi cal dental program. This document does not replace the detailed information in the medi cal dental provider handbook. The medical dental program covers many services to keep your teeth healthy. The california medi cal dental program provider handbook, also known as the denti cal handbook is updated with the information from the denti cal bulletins each quarter. Iehp medi cal member services 800 4404347 800 7184347 tty iehp dualchoice member services 877 2734347 800 7184347 tty iehp 24hour nurse advice line for iehp members only.
The pages reflect changes made to the dentical program during the month of january 2018. Visit denti cal at the california dental association convention cda presents in san francisco 2016. Provider handbook welcome to the medical dental program. You should look at the member handbook for a detailed description of coverage benefits and limitations. Dentical program for inpatient and outpatient services denti io abstract. Medical access for infants and mothers aim program entire handbook. Adult dental benefits that will remain in place and do not change as a result of the 2014 or 2018 restorations. Sincerely, denti cal galkomia medi gal dental program provider enrollment enclosures. Hpsms medical program received accreditation from the national committee for quality assurance ncqa on january 17, 2020. Your primary care physician pcp will do a dental screening and refer you to a dentist for dental care. All plans offer the same standard benefits plus extra benefits. Saving your location allows us to provide you with more relevant information.
In addition to the above information, on march 17, 2020. See section 3, enrollment requirements, of the medical dental program provider handbook. California medicaid medical dental services dentical. Staff from the department of health care services, and the medi cal fiscal intermediary provided information on medi cal eligibility and billing and medi cal managed care. Also known as the california medical dental program provider handbook, it is updated with the information from the dentical bulletins each quarter.
1469 1533 403 1139 1293 1098 859 720 704 1291 1188 1328 61 1333 1454 140 1379 928 378 625 1252 754 632 339 504 336 349 1485 701 774 1179 729 1279 156 243 1268