E NUMBER CITY STATE FAX FORMS REORDER REQUEST TO: (877) 401-7534 OR MAIL TO: Denti-Cal Forms Reorder 11155 International Dr. MS C210 Rancho Cordova, CA 95670 ZIP CODE DC-202 (no carbon required) DC-209 (continuous pin-fed form) DC-217 (for laser printers) DC-206 (for TAR/Claims) DC-214A (large X-ray envelopes) DC-214B (small X-ray envelopes) TREATMENT AUTHORIZATION REQUEST (TAR)/CLAIM FORMS and Envelopes Miscellaneous Inventory DC-003 Claim Inquiry Form (CIF) DC-007 (CIFs and Corre.
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How to fill out the Medi-Cal Rendering Provider Application/Disclosure online
The Medi-Cal Rendering Provider Application/Disclosure is essential for individuals seeking to provide dental services under the California Medi-Cal Dental Program. This guide will walk you through the steps to effectively complete the form online.
Follow the steps to fill out the form successfully.
- Press the ‘Get Form’ button to access the document and open it for editing.
- Begin by entering the billing provider name. This is the name of the individual or organization submitting the application.
- Fill in your NPI (National Provider Identifier) number and billing number. These identifiers are crucial for the processing of your application.
- Provide the complete mailing address, including city, state, and ZIP code. Ensure accuracy to avoid delays in communication.
- Enter your telephone number and any relevant fax number where necessary. This will facilitate easy communication with Medi-Cal.
- Select the forms you wish to reorder based on your needs from the listed options, including various claim forms and envelopes.
- Indicate the quantity required for each form you are ordering, ensuring you select a number that meets your operational requirements.
- Review all the information provided for accuracy. It is crucial to ensure that there are no errors before submission.
- Save the changes made to the form. You may also download, print, or share the completed form as needed.
Complete and submit your documents online to ensure efficient processing.
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How do I find a dentist that accepts Medi Cal?
You can find a Medi-Cal dentist on the Medi-Cal Dental Provider Referral List, or by calling 1-800-322-6384.
How do you qualify for Denti Cal?
You will need to find a dentist or dental clinic that accepts Medi-Cal and seek an appointment. You can find a Medi-Cal dentist on the Denti-Cal website at http://www.denti-cal.ca.gov by clicking on Find a Medi-Cal Dentist. You can also call Denti-Cal at 1-800-322-6384.
How do I become a Denti Cal provider?
Contact the Provider Telephone Service Center at 1-800-423-0507 to receive an application packet by mail or; Download and print applications from the Provider Enrollment page of the Medi-Cal Dental website at www.dental.dhcs.ca.gov - Providers/Application Forms.
Does Denti Cal pay for implants?
For example, as we saw in Maggie's story, Denti-Cal covers full dentures but not partial dentures, bridges or implants, leaving many older adults with the choice of either pulling out all their teeth or getting no treatment.
Is Medi Cal the same as Denti Cal?
For Dental Services, you can choose Medi-Cal Dental, known as Denti-Cal, or a Managed Care Dental Plan.
What is Denti Cal program?
Under the guidance of the California Department of Health Care Services, the Medi-Cal Dental Program aims to provide Medi-Cal members with access to high-quality dental care. ... This website provides important information about the Medi-Cal Dental Program for members and providers.
Can I get braces with Denti Cal?
Does Medi-Cal Cover Braces? Yes. But, not everyone with Medi-Cal/Denti-Cal qualifies for benefits. ... Patients covered by a managed care plan through the Denti-Cal program, in certain cases, will not have orthodontic benefits.
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