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Governor Brown

Provider Related Frequently Asked Questions

General FAQs

The questions are grouped and organized into the following topics:

Application Package

  1. What are the requirements for enrollment in the Medi-Cal Dental ("Denti-Cal") program?
    Providers must be licensed and accredited according to the specific laws and regulations that apply to their service/provider type. 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. Provider enrollment regulations, California Code of Regulations, Title 22, Section 51000 et.seq. and Section 51000.60, list the application criteria, which include having an established place of business and proof of liability insurance coverage and professional liability insurance coverage, as required.

  2. Where can potential providers obtain the enrollment applications?
    Provider application packages are available by either contacting the Provider Telephone Service Center at 1-800-423-0507 to receive an application packet by mail or by downloading and printing the applications from the Provider Enrollment page of the Denti-Cal Web site at www.denti-cal.ca.gov - Providers/Application Forms.

  3. Can an applicant or provider talk to someone if s/he has questions about filling out an application?
    Applicants are encouraged to carefully read the application instructions provided with the forms. Applicants may call 1-800-423-0507 or submit questions in writing to:

           California Medi-Cal Dental Program
           Provider Enrollment
           P.O. Box 15609
           Sacramento, CA 95852-0609

  4. Can an applicant or provider submit a photocopy of the application package?
    A photocopy of the application is acceptable; however, the signature must be original. Stamped, faxed or copied signatures are not acceptable. Although the form may be photocopied, it is unlawful to alter it in any manner. If a mistake is made entering information on a form, line through the mistake and initial it. Do not use correction tape, white out, etc. to make corrections.

  5. Who can sign the enrollment application package?
    The package must be signed by the dental provider who is the sole proprietor, partner, corporate officer or an official representative of a governmental entity or non-profit organization, who has the authority to legally bind the applicant seeking enrollment as a Denti-Cal provider. A biller or office manager is not a valid signatory. Include a legible, current copy of the driver's license or state-issued identification card number of the authorized person signing the application. Enlarged copies work best.

  6. Where does an applicant or provider submit the completed Dental application package?
    Completed forms should be sent to:

           California Medi-Cal Dental Program
           Provider Enrollment
           P.O. Box 15609
           Sacramento, CA 95852-0609

  7. Can the applicant or provider submit the application package by fax?
    No. Applications must have original signatures. Stamped, faxed or copied signatures are not acceptable.

  8. What happens if all the required information is not included in the application?
    An application package that is incomplete will be returned to the applicant with an explanation of what information is missing. If new regulations or statutes become effective during the application review, the applicant will be given the opportunity to submit any new required information. All Denti-Cal providers are expected to comply at all times with all current statutes and regulations governing the Medi-Cal Dental program (Denti-Cal).

  9. What happens if an applicant or provider does not return his/her corrected application package to Provider Enrollment within 60 days as specified on the initial notification that the application package is incomplete?
    If the applicant returns his/her corrected application package to Provider Enrollment after the specified 60 days, the resubmitted application is treated as a new application and the 180-day application process clocks starts over again. However, if the complete application package with all the required and requested documentation is received within the 60 days of the initial notice, processing continues, up to 60 additional days.

  10. Which officials in a non-profit organization must be reported on the Denti-Cal Application (form DHCS 5300)?
    Most non-profit organizations are run by a governing board (e.g., Board of Directors). As such, each member of the applicable governing board must be reported. Additionally, although the vast majority of non-profit organizations do not have owners, any individual who owns at least 5 percent of the non-profit organization must be reported.

  11. How does the Denti-Cal Program define and use the two addresses requested on the applications?
    • The Business Address is the actual physical location of the business to include the street name and number, city, state and zip code. General correspondence, not otherwise specifically identified below, is sent to the Business Address. Post office or commercial boxes are not acceptable.
    • The Pay-To-Address is the address at which the provider wishes to receive payment. Post office or commercial boxes are acceptable.
      Note: Once enrolled, providers may elect to have their payments electronically deposited into their financial institution. Information regarding electronic fund transfer is available in the Denti-Cal Provider Handbook.
  12. Can an application be delivered in person to the Provider Enrollment Department?
    No. An application package must be sent to:

           California Medi-Cal Dental Program
           Provider Enrollment
           P.O. Box 15609
           Sacramento, CA 95852-0609

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Provider Numbers

  1. How does a provider of dental services obtain a Denti-Cal provider number?
    To receive a Denti-Cal provider number, the appropriate application package must be submitted. For example, a dentist new to Denti-Cal must submit a Denti-Cal Provider Application (form DHCS 5300) and the required attachments, including a copy of a driver's license or state-issued identification card, a copy of his/her dental license, a copy of the certificates of insurance coverage and professional liability insurance coverage, and other documentation as listed on the DHCS 5300.

  2. How is a provider notified of the provider number?
    Providers receive a Welcome to the Medi-Cal Dental Program (Denti-Cal) letter when the application is approved and entered into the Provider Master File. The letter is mailed to the provider's business/mailing address listed on the application. Approval letters contain the new provider number, effective date of enrollment, and the address at which the services are provided. However, rendering providers to a group are not individually notified, rather correspondence is sent to the group's business address after the rendering provider has been added.

  3. How long does the application process take before an applicant receives a provider number?
    Applications are reviewed based on the date received. Timeframes for processing an application package are specified in statute, Welfare and Institutions Code (W & I Code), Section 14043.26, and regulation, California Code of Regulations (CCR), Title 22, Section 51000.50. Within 10 days of receipt of an application package, a post card notification is mailed to the applicant or provider. Within 180 days, the applicant is notified in writing of one of the following:
    • The application is approved for enrollment as a provisional provider,
    • The application is incomplete and additional information is required,
    • The application is referred for a comprehensive review and background check, or
    • The application is denied with the reason(s) for denial.
    • NOTE: As long as the applicant or provider responds within 60 days of the notice that the application package is incomplete, processing continues. Within 60 days of receipt of the resubmitted complete package, notification of approval, referral for comprehensive review and background check, or denial, is mailed to the applicant or provider. This notice is mailed to the service or business address listed on the application.

  4. When can a provider number be deactivated without notification?
    A provider number shall be deactivated when either:
    • Documents mailed to the service or business address or the pay-to-address were returned by the United States Postal Service as not deliverable. Prior to deactivating a provider number for either of the stated reasons, the Denti-Cal Program makes an attempt to contact the provider by telephone or writing, or;
    • A licensee has an inactive, denied, suspended or delinquent license with the Dental Board of California;
    • A claim has not been submitted for reimbursement from the Denti-Cal program for one year;
    • Failure to revalidate an enrolled service office location.
    • NOTE: If unable to make contact, Provider Enrollment is required to deactivate the provider number immediately without prior notice. For additional information about deactivation for returned mail, please refer to W & I Code, Section 14043.62(a)

  5. When deactivated for returned mail or billing inactivity, how can a provider number be reactivated?
    Submission of a complete application package specific to the provider type is required. (Deactivation due to Department sanctions is subject to specific qualifications not discussed here. Detailed information is included with the written notification to the sanctioned provider).

  6. What are the important points to remember about the unique provider number?
    • Each provider has agreed to abide by all Medi-Cal laws and regulations, program policies and procedures as published in the Denti-Cal Provider Handbook. Title 22 of the California Code of Regulations (CCR), Section 51501(d) states in relevant part that no provider shall submit claims to the Medi-Cal Program using any provider number other than that issued to the provider by the Medi-Cal Program.
    • Remember that without approval of the Medi-Cal application and the issuance of a dental provider number or provisional dental provider number, services rendered to Medi-Cal dental patients will be denied.

  7. Can a dental provider see patients prior to approval of the application and issuance of the provider number?
    No.

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Reporting Changes to Provider Enrollment

  1. How does a provider notify Denti-Cal of a change to an existing provider's entity type?
    (i.e., change from sole proprietor to a corporation or a partnership) Changes in entity type require the submission of a new complete enrollment application.

  2. How does a dental provider notify Denti-Cal of a change to existing provider information?
    A dental provider is responsible for notifying the Denti-Cal Program within 35 days of any change in previously submitted information. Failure to do so may result in deactivation. A provider is required to submit the Medi-Cal Supplemental Changes (form DHCS 6209) to:
    • Add or change a business telephone number;
    • Add or change the name under which the provider is doing business as (DBA);
    • Request the deactivation of a provider number or group provider number;
    • Request re-issuance of a Provider Identification Number (PIN);
    • Delete a rendering provider from a provider group;
    • Report a change of less than 50 percent in the ownership or control interest of a provider or provider group. (A change of 50 percent or more in the ownership or control interest of a provide or provider group requires the submission of a new application.);
    • Change the pay-to-address or address where the provider would like payments sent;
    • Change managing employees;
    • Change hours of operation;
    • Change business activities.

  3. How does a dental provider notify Denti-Cal of a change in business address?
    Effective January 1, 2004, a provider that is:
    1. Adding an additional location to that currently used to provide dental services to Medi-Cal recipients, and for which the provider was issued a provider number, shall submit a complete application package. (W & I Code, Section 14043.26(a)(1)), or
    2. Changing location and moving to a different location than that for which the provider was issued a provider number, shall submit a complete application package.
    3. NOTE: This does not apply to licensed clinics, licensed health facilities, licensed adult day health care providers, licensed home health agencies and licensed hospices (W & I Code, Section 14043.26).

  4. What are the requirements for changes to my dental practices?
    A dental practice must adhere to the Dental Board of California (DBC) requirements as stated below, and report any changes within one month after making said change. Please contact the DBC for any additional questions regarding changes to your dental practice.
    • Dental Board Requirements for Change of Office - Dental Practice Act Article 3. Registration 1651. Change of Office. In the event any licensed dentist fails to notify the board of any change in the address of his place of practice within the time prescribed by this section, the board shall not renew such person's license until the penalty fixed by this chapter is paid. An applicant for renewal of a license to practice dentistry shall specify in his application whether he has changed the address of his place of practice, and if so, the date of such change, and the board may accept such statement as evidence of such facts.

  5. How does a dental provider terminate enrollment as a Denti-Cal provider?
    A Medi-Cal provider number can be terminated by the submission of a Medi-Cal Supplemental Changes (form DHCS 6209) requesting to deactivate a provider number under the Miscellaneous section or by submitting a letter in writing with his\her request to deactivate\terminate their provider number. The provider(s) must sign the letter and include a legible, valid copy of the driver's license or state-issued identification card number.

  6. How does a dental provider notify Denti-Cal of a Change of Ownership?
    Changes in ownership (or control interest) of less than 50 percent or more require submission of a Medi-Cal Supplemental Changes (form DHCS 6209). In addition, changes in ownership (or control interest) of 50 percent or more of an enrolled provider require submission of a complete application.

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Billing For Services

  1. When can a dental provider begin billing for goods or services provided to Medi-Cal dental recipients?
    Prospective Medi-Cal dental providers must apply and be enrolled in the Denti-Cal program, be assigned a provisional provider number and agree to conditions of participation before payment can be made for services furnished to Medi-Cal dental recipients. The effective date on the enrollment letter is the date a provider can begin billing for services. Rendering providers cannot directly bill, rather, the group bills Denti-Cal for services rendered by the rendering provider.

  2. Who can a provider contact with a question regarding billing and claims information?
    Providers should contact the Telephone Service Center at 1-800-423-0507 or visit the Denti-Cal Web site at www.denti-cal.ca.gov.

  3. How can a provider enroll in Electronic Funds Transfer (EFT)?
    All active Medi-Cal dental providers electing this option are required to enroll. The EFT Direct Deposit Enrollment Form and instructions are located at the following link: www.denti-cal.ca.gov or by contacting the Telephone Service Center at 1-800-423-0507 to request the direct deposit enrollment form. The provider must send the completed form and a pre-printed voided check to:

           California Medi-Cal Dental Program
           Provider Enrollment
           P.O. Box 15609
           Sacramento, CA 95852-0609

    The form is returned to the provider if it is not completed correctly.

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General Questions

  1. Where can a provider find out more information about enrollment into the Denti-Cal program?
    Denti-Cal encourages potential applicants and providers to review the application forms and enrollment regulations available on the www.denti-cal.ca.gov and www.medi-cal.ca.gov web sites. The regulations contain enrollment criteria and terminology, processing timelines and notes regarding applicable statutes, as well as the requirements for participation in the Denti-Cal program.

  2. Do cellular phones qualify as a business telephone?
    No. Business telephone means the telephone number at the business address of the applicant or provider. A beeper number, answering service, biller or billing service, pager, facsimile machine, answering machine or a cellular phone shall not be used as the primary business telephone.

  3. What is an Established Place of Business?
    An applicant or provider shall be required to demonstrate an "established place of business" appropriate and adequate for the services billed or claimed to the Denti-Cal program, as relevant to his or her scope of practice, as indicated by, but not limited to, the following:
    1. Being open and available to the general public.
    2. Having regularly established and posted business hours.
    3. Having adequate supplies in stock on the premises.
    4. Meeting all local laws and ordinances regarding business licensing and operations.
    5. Having the necessary equipment and facilities to carry out day-to-day business for his or her practice.
    6. NOTE: Denti-Cal may make announced or unannounced visits to any applicant or to any provider for the purpose of determining whether enrollment, continued enrollment, or certification is warranted, or as necessary for the administration of the Denti-Cal program.
    7. NOTE: Failure to remediate significant discrepancies in information provided to the department by the provider or significant discrepancies that are discovered as a result of an announced or unannounced visit to a provider, for purposes of enrollment, or continued enrollment shall make the provider subject to temporary suspension from the Medi-Cal program, which shall include temporary deactivation of all provider numbers used by the provider to obtain reimbursement from the Denti-Cal program. The director shall notify in writing the provider of the temporary suspension and deactivation of provider numbers.

  4. How does a provider request a Personal Identification Number (PIN) that has been misplaced or lost?
    Please fill out and return the Medi-Cal Supplemental Changes (form DHCS 6209) to Denti-Cal. Once we receive your completed form, your request will be processed.

  5. What determines the effective date?
    The effective date of enrollment is the date a complete application is received by Provider Enrollment, which is identified on a notice issued to the provider to acknowledge the application was received.

  6. How does enrolling in Electronic Data Interchange (EDI) benefit a dental provider?
    You can find out why it is beneficial to sign up for EDI by going to the EDI page.

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Dental Practice Business Requirements

  1. What are the requirements in filing a Fictitious Name?
    All dentists using a business name other than their licensed name are required to obtain a fictitious name permit issued by the Dental Board of California. The permit is renewable every two years and coincides with the dental license renewal date of the permit holder. Before submitting your application and fees, direct all questions regarding the use of a name for your practice with the Dental Board of California.

    Permits Are Invalid When:
    • Any change of address from that specified on the permit occurs.
    • Any change in the name style as specified on the permit occurs. This would include a sale of practice and a new owner.
    • Any change in the status under which application was made, for example:
      1. Dissolution of partnership, etc.
      2. A change from sole proprietor to partnership, etc.
      3. A change from three sole practitioners (group) who own or lease the place of practice to a pair of dentists, or to a single dentist.

    If any of the above changes occur, and continued use of the same fictitious name is desired, contact the Dental Board of California at www.dbc.ca.gov.

  2. When am I required to have an Additional Office Permit?
    Any licensed dentist who has ownership or control in any dental practice other the primary location, you must obtain an additional office permit with the Dental Board of California.
    For additional clarification regarding additional office permits, contact the Dental Board of California at www.dbc.ca.gov.

  3. What are the requirements for a dental practice when changing to a dental corporation?
    Licensed dentists who are incorporating their dental practice are recommended to contact the Dental Board of California for the guidelines. The filing of the dental corporation name must comply with the Dental Practice Act, Business and Professions Code, Section 1804, listed below:

    BUSINESS AND PROFESSIONS CODE
    SECTION 1804

    1804. Notwithstanding subdivision (i) of Section 1680 and subdivision (g) of Section 1701, the name of a dental corporation and any name or names under which it may be rendering professional services shall contain and be restricted to the name or the last name of one or more of the present, prospective, or former shareholders and shall include the words "dental corporation" or wording or abbreviations denoting corporate existence, unless otherwise authorized by a valid permit issued pursuant to Section 1701.5.

  4. What is the requirement to operate a Mobile Dental Clinic?
    A mobile dental clinic permit may be issued by the Dental Board of California to a licensed dentist who intends to practice dentistry in a self-contained facility that may be moved, towed, or transported from one location to another. The clinic must meet all applicable laws, regulations, and ordinances. The applicant must possess all required state, county and city licenses to operate the clinic. For clarification regarding the Mobile Dental Clinic Permit, contact the Dental Board of California, or visit their website at: www.dbc.ca.gov.

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