Provider Related Frequently Asked Questions (FAQs)

The questions are grouped and organized into the topics listed below. Click on a FAQ link below to see the response.

Claims

Top Reasons for Claim Denials

Treatment Authorization Requests (TARs)

Top Reasons for Treatment Authorization Denials

Telephone Service Center (TSC)

Common Call-In Questions

Provider Enrollment

How do I enroll in the Medi-Cal Dental Program?

On October 31, 2022, DHCS implemented the Provider Application and Validation for Enrollment (PAVE) Provider Portal to simplify and accelerate Medi-Cal enrollment processes for dental providers. The PAVE portal is a web-based application that allows dental providers to submit enrollment applications and required documentation to DHCS electronically.

For all enrollment related questions

Please contact PED using the Inquiry Form found on PED's website under "Provider Resources" at www.dhcs.ca.gov/provgovpart/Pages/PED.aspx. You can also call the PED Message Center at (916) 323-1945.
For PAVE application questions, email PED at PAVE@dhcs.ca.gov, or send a message in PAVE.
For PAVE technical support, please call the PAVE Help Desk at (866) 252-1949. The Help Desk is available Monday-Friday from 8:00am-6:00pm, excluding State holidays. You can also use the PAVE Chat feature while in PAVE. Chat is available Monday-Friday from 8:00am-4:00pm, excluding State holidays.

Provider Numbers

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 Medi-Cal Dental 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 which for enrollment purposes is the provider's National Provider Identifier (NPI)

Billing for Services

Who can a provider contact with a question regarding billing and claims information?

How can a provider enroll in Electronic Funds Transfer (EFT)?

Providers can sign up for EFT when they submit their application in PAVE. There is an EFT question in the application package. If a provider does not set up EFT in the application, then they can still do so after their application is approved and they are enrolled in Medi-Cal. Instructions for completing the EFT enrollment form may also be found on the Providers Application Forms page of the Medi-Cal Dental website at www.dental.dhcs.ca.gov.

General Questions

How does a provider request a Personal Identification Number (PIN) that has been misplaced or lost?

For written confirmation of an existing PIN or request for a new PIN, send a written request to Medi-Cal Dental at PO Box 15609, Sacramento, CA 95852-0609. A PIN cannot be confirmed or issued over the telephone. If you have additional questions regarding your PIN, please call the Medi-Cal Dental Telephone Service Center (TSC) at (800) 423-0507. TSC Representatives are available Monday-Friday from 8:00am-5:00pm.

How does enrolling in Electronic Data Interchange (EDI) benefit a dental provider?

Business Requirements

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.