Dental Case Management Program
The Medi-Cal Dental Case Management program is designed to assist Medi-Cal members with special health care needs who are unable to schedule and coordinate complex treatment plans among multiple practitioners. Examples of special health care needs include: Physical, developmental, mental, sensory, behavioral, cognitive or emotional impairment or limiting condition that requires medical management, health care intervention and/or use of specialized services or programs. Case Management and Care Coordination Services are closely related and provide specific yet different services to members.
Care Coordination Services allow Medi-Cal members to call and gain access to dental services with the direction and support of our TSC representatives, who assist members with locating a general or specialist dentist, transportation and translation services. A TSC representative will also initiate contact with a member or member representative if a case is referred for care coordination from the Case Management team.
Case Management is an extension of the Care Coordination services offered by the Telephone Service Center (TSC) representatives when a Medi-Cal member calls for assistance. Case Management Representatives will be available to provide assistance to dental providers on a referral basis to manage complex treatment plans and oral health care needs.
Case Management Referral
Referrals for Case Management services are initiated by the member's Medi-Cal Dental provider and based on a current, comprehensive evaluation and treatment plan. All referrals will be evaluated to determine eligibility for Case Management. If criteria is met, a Case Management Representative will initiate contact with the member or member representative.
To ensure all referrals are handled accurately and efficiently, referrals that do not meet Case Management criteria will be forwarded to Care Coordination for further assistance.
As a Medi-Cal Dental provider, you may refer patients to Case Management by completing the secure online referral form. After completing the referral form, you must press the submit button at the bottom of the referral page to send the referral form for evaluation.
Please visit our Provider Forms Page/Dental Case Management section to download and submit a Case Management Referral form.
If you have questions when submitting an online referral, please contact Denti-Cal Telephone Service Center at 1-800-423-0507.