Dental Transformation Initiative Domain 1 Resources
In alignment with the CMS Oral Health Initiative, this program aims to increase the statewide proportion of children ages 1 through 20 enrolled in Medi-Cal who receive preventive dental services in a given year. The goal is to Increase statewide proportion of children ages 1 through 20 enrolled in Medi-Cal who receive a preventive dental service by 10 percentage points over a five-year period.
- Domain 1 Payment Table – Program Year 1
- Domain 1 Payment Table – Program Year 2
- Domain 1 Payment Table – Program Year 3
- Domain 1 Fact Sheet (Domain eligible codes are available on Page 2)
- Domain 1 Revised Payment Methodology
- Sample Domain 1 Explanation of Payment Statement
Safety Net Clinic Resources for Data Submission
The claim submission deadline for Domain 1 has been updated. Providers must submit all DTI related claims by January 14, 2022, for payment consideration. Claims submitted after this date may not be considered for payment. All payments are subject to authorized funding authority.
Note: DHCS recommends that SNCs submit data electronically, rather than via proprietary form.
- SNC Frequently Asked Questions and Answers (Revised as of July 19, 2017)
- Encounter Data Submission Process for SNCs – PowerPoint (Revised as of September 17, 2018)
- Encounter Data Submission Process for SNCs
- DTI Proprietary Encounter Form for Paper Billing
- Opt-in Form
Contact Us
Please direct your comments, questions, or suggestions regarding the DTI to : DTI@dhcs.ca.gov.