Delta Dental State Government Programs (Denti-Cal)
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1 Delta Dental State Government Programs (Denti-Cal) July
2 The following presentation is not for consumer use and is for informational purposes for the 2014 Stronger Bridges to Health Forum. 2
3 Department of Health Care Services Medi-Cal Dental Programs 3
4 Department of Health Care Services Medi-Cal Dental Programs Medi-Cal Dental Program Dental Managed Care Capitation plan Denti-Cal Fee-For-Service 4
5 Medi-Cal Dental Program Dental Managed Care Sacramento County Los Angeles County Option to opt out of Managed Care Denti-Cal Remaining 56 Counties 5
6 Denti-Cal 6
7 Denti-Cal Program Beneficiary Benefits 7
8 Denti-Cal Program Beneficiary Benefits Children less than 21 years of age Individuals- 21 years of age and over Specific services for pregnant individuals Services for Regional Center Consumers Facility Residents 8
9 Denti-Cal Program Benefits Under 21 year of age Examination and x-rays Cleaning and fluoride treatment Sealants Fillings, crowns Extractions Root Canals Braces Appliances to replace missing teeth Full dental benefits as prescribed in the Medi-Cal Dental Program Provider, Section 5: Manual of Criteria and Schedule of Maximum Allowances Source: Denti-Cal Beneficiary Boucher 9
10 Denti-Cal Program Benefits 21 years of age and over Comprehensive oral evaluation Adult prophylaxis Topical Fluoride Fillings, crowns Extractions Root Canals (Front Teeth) Dentures 10
11 Denti-Cal Program Benefits Pregnant Women X-rays Comprehensive oral evaluation Periodic oral evaluation Adult prophylaxis Topical Fluoride Periodontal scaling and root planning Gingivectomy or gingivoplasty Osseous surgery Limited occlusal adjustment Plus additional services pending eligibility Source: Denti-Cal Bulletin, May 2012, vol.28, no. 7, website: 11
12 Regional Center Consumers (Department of Developmental Services beneficiaries) Eligible Regional Center Consumers not residing in a licensed health care facility (Skilled Nursing Facilities or Intermediate Care Facilities) Similar dental benefits as Denti-Cal beneficiaries under 21 Follow Denti-Cal Criteria for procedures in Provider Hand book, Section 5: Manual of Criteria 12
13 Facility Residents Residents residing in a qualifying Skilled Nursing Facilities or Intermediate Care Facilities Similar dental benefits as Denti-Cal beneficiaries under 21 Follow Denti-Cal Criteria for procedures in Provider Hand book, Section 5: Manual of Criteria 13
14 Accessing Information Denti-Cal Website 14
15 Denti-Cal Home Page 15
16 Denti-Cal Website Home Page Top Tab links Most Popular Links What s New & Important Reminders 16
17 Top Tab Links Home Provider Beneficiaries Outreach Publication HIPAA NPI Dental Managed Care Statutes and Regulations Health Families Transition 17
18 Most Popular Links Provider Bulletin Provider Handbook Dental Resources Provider Seminars Stop Fraud and Abuse 18
19 What s New & Important Reminders What s New Recent Denti-Cal bulletins Denti-Cal Web Tutorial Important Reminders Denti-Cal & Family Program Providers Survey Expanded Rules for NPI Usage Dental Periodicity Schedule for Children Update your Patient Referral information 19
20 Beneficiary Services Denti-Cal Website 20
21 Beneficiaries Services Denti-Cal website Help in locating a Medi-Cal dentist Beneficiary Telephone Service Center Form to Request Protected Health Information from Denti-Cal Return of some Medi-Cal Adult Dental Benefits 21
22 Beneficiaries Locate a Dentist Help in locating a Medi- Cal dentist InsureKidsNow.gov Search Engine Dental Referral List by Counties 22
23 Dental Educational Material 23
24 Dental Managed Care Dental Informing materials 24
25 Dental informing Materials Dental educational brochure Six Languages Chinese English Hmong Russian Spanish Vietnamese 25
26 Dental Informing materials (Six Different Languages) 26
27 Thank you 27
28 Denti-Cal Outreach Unit International Drive, C25 Rancho Cordova, CA Walter Lucio, DDS, MPH Michelle Brucklacher Nichol Gibson FAX
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