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Dental Authorizations & Claims

Dental/Orthodontic Authorization Process

Claims Processing

Billing Questions

 

Dental/Orthodontic Authorization Process

All requests for CCS dental and orthodontic services for CCS Only and CCS Healthy Families clients (CCS does not cover medically handicapping malocclusion for clients with Medi-Cal full-scope no share of cost eligibility; these clients are to be referred to Denti-Cal) must be submitted using a DHS 4516 form, CCS Dental and Orthodontic Client Service Authorization Request (SAR).  Once a dental/orthodontic SAR has been received by CCS and entered into the system, all necessary dental/orthodontic procedures will be authorized by Denti-Cal. Only active Denti-Cal Providers may receive authorization to provide CCS program services. Services may be authorized for varying lengths of time during the CCS client’s eligibility period.

Some helpful tips when submitting a dental/orthodontic SAR:

  • Dental providers must request CCS services using a Dental/Orthodontic SAR form.
  • Each SAR submitted to CCS is reviewed for residential and financial eligibility (unless a Healthy Families subscriber) to determine child's program eligibility.
  • All dental/orthodontic SARs are issued pending review by Denti-Cal/Delta Dental for authorization.
  • Denti-Cal will not authorize any procedures for CCS without a matching SAR.
  • CCS follows all of Denti-Cal's policies, procedures, and requirements.
  • Providers should not proceed with treatment until an authorization is received from Denti-Cal (unless Denti-Cal does not require prior authorization for a specific service--see Denti-Cal Provider Manual Section 4, Program Policy).  
  • All orthodontic services require prior authorization from Denti-Cal. 

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Claims Processing

Claims for services that have been authorized by CCS or Denti-Cal are to be submitted directly to Denti-Cal.

  • Submit claims for services that were approved or authorized by the CCS program or Denti-Cal. Claims for services without CCS or Denti-Cal approval or prior authorization may be denied.
  • Submit claims for services rendered to a client confirmed eligible to receive CCS benefits. Claims for services rendered to clients who are not CCS or are no longer eligible to receive CCS benefits will be denied.
  • Submit claims to Denti-Cal in a timely manner.

Submit claims for services rendered to clients with other health insurance coverage with the Explanation of Benefits (EOB) attached to the claims.

 

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Billing Questions

If you have billing questions, please contact Delta Dental at (800) 423-0507. You can also visit the Denti-cal Website for billing procedures and updates.


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