Cov ntaub ntawv thov kev kho hniav
Dental providers may apply for enrollment in the Medi-Cal Fee-For-Service program as individuals, group providers, rendering providers, ordering/referring/prescribing providers, or crossover-only providers by submitting an electronic application through the Provider Application for Validation and Enrollment (PAVE) online enrollment portal, along with all supporting documentation. For more information, please see the regulatory provider bulletin titled, “Updated Requirements and Procedures for the Enrollment of Medi-Cal Dental Providers.”
DHCS tsis lees txais daim ntawv thov kev pab cuam los ntawm cov kws kho hniav txij li lub Kaum Hlis 31, 2022.
Cov kws kho hniav muaj xws li cov kws kho hniav muaj ntawv tso cai, cov kws kho hniav sau npe, cov kws kho hniav sau npe hauv lwm txoj kev xyaum, thiab cov kws kho hniav sau npe hauv kev ua haujlwm txuas ntxiv. Txawm li cas los xij, cov kws pab kho hniav, cov kws pab kho hniav sau npe, lossis cov kws pab kho hniav sau npe hauv cov haujlwm txuas ntxiv tsis tau tso cai rau npe lossis sau nqi Medi-Cal ncaj qha.
Cov Kev Pab Kho Hniav rau PAVE
- Taw qhia rau PAVE rau Cov Kws Kho Hniav
- Basic Functions in PAVE for Dental Providers
- Demo 2: Intro to PAVE Dental FAQs
Daim ntawv thov yuav tsum tau rau cov kws kho hniav
Txhua tus neeg thov kev kho hniav thov rau npe, hloov pauv rau npe, lossis txuas ntxiv mus rau npe hauv Medi-Cal Fee-For-Service program yuav tsum xa daim ntawv e-Form los ntawm PAVE online system, muaj nyob ntawm PAVE lub vev xaib.
Kev Tsim Nyog Rau Tus Kws Pab Tswv Yim Zoo Tshaj Plaws
Cov kws kho hniav uas muaj ntawv tso cai tuaj yeem thov, thiab muab cov ntaub ntawv pov thawj thiab pov thawj rau, txiav txim siab rau kev tso npe rau hauv Medi-Cal qhov kev pab cuam raws li tus neeg muab kev pab cuam uas xav tau. Cov Kev Pabcuam Ib ntus uas xav tau ua kom luv luv rau lub sijhawm rau DHCS cov lus teb los ntawm 180 hnub mus rau 150 hnub. Txawm li cas los xij, txhua qhov kev xav tau tseem yuav tsum tau ua tiav. Cov xwm txheej xav tau tuaj yeem ntsib yog tias tag nrho cov lus hauv qab no muaj tseeb:
- Tus neeg thov tau txais daim ntawv tso cai tam sim no raws li kws kho hniav muab los ntawm Pawg Saib Xyuas Kev Kho Hniav ntawm California, uas tsis tau muab tshem tawm, txawm tias nyob los yog tsis, raug ncua, muab tso rau hauv kev sim, lossis raug rau lwm yam kev txwv;
- Tus neeg thov kev pabcuam tam sim no tau tso npe ua tus kws kho hniav los ntawm txoj kev pabcuam khomob uas muaj ntawv tso cai raws li Knox-Keene Health Care Service Plan Act xyoo 1975;
- Tus neeg thov kev pab yeej tsis tau muab tshem tawm thiab/lossis ncua kev tso cai los ntawm California Medicaid program Medi-Cal Dental; thiab
- Tus neeg thov tsis muaj qhov cuam tshuam tsis zoo hauv Healthcare Integrity and Protection Data Bank/National Practitioner Data Bank (HIPDB/NPDB).
Kev Sau Npe Kawm Qib Siab
Cov kws kho mob hauv tsev kawm ntawv tau lees paub University cov tsev kawm kho hniav. Cov kws kho mob yuav tsum tau qhia nyob rau hauv daim ntawv thov e-Form tias lawv tab tom thov ua tus kws kho mob hauv University thiab upload daim ntawv tso cai kws qhia ntawv lossis ib tsab ntawv los ntawm Lub Tsev Kawm Ntawv uas xaiv tus thawj coj kho hniav.
Rendering Physician Enrollment
Cov kws kho mob muab kev pabcuam rau cov pab pawg kws kho hniav yuav tsum xa daim ntawv thov e-Form ua tus muab kev pabcuam txuas rau lawv mus rau pawg kws kho hniav thiab yuav tsum xa daim ntawv tso cai kws khomob / kws phais mob siv tau nrog rau daim ntawv tso cai Medical General Anesthesia.
Cov Ntawv Teev Npe Tshwj Xeeb
- Facility-Based Dental Provider Enrollment
A “facility-based provider” is defined as a natural person or professional corporation enrolled as a provider who renders services to Medi-Cal beneficiaries exclusively in one or more licensed health facilities or health-related facilities. Details on the requirements and procedures for this type of enrollment are outlined in the regulatory provider bulletin titled, “Updated Requirements and Procedures for Enrollment as a “Facility-Based Provider“.” Facility-based providers must indicate within the e-Form application that they are applying for enrollment as a facility-based provider and submit the attestation letters outlined in the aforementioned provider bulletin.
- Kev Sau Npe Rau Tsev Kawm Ntawv Tus Kws Kho Hniav
Cov tsev kawm ntawv muab kev pabcuam rau cov tub ntxhais kawm theem pib, theem nrab, lossis theem siab hauv tsev kawm ntawv. Cov chaw zov me nyuam no yuav tsum tso npe siv lub tsev kawm ntawv chaw nyob ua lawv qhov chaw nyob, qhia hauv daim ntawv thov e-Form tias lawv tab tom thov ua tus kws kho mob hauv tsev kawm ntawv thiab xa daim ntawv cog lus kos npe ntawm tsev kawm ntawv thiab tus kws kho mob.
- Mobile Dental Clinic Sau npe
Cov chaw kho mob txawb yuav tsum tau qhia tias lawv tab tom thov rau npe ua lub chaw kho hniav mobile hauv daim ntawv thov e-Form. Cov neeg muab kev pabcuam no tseem yuav tsum tau:
- Nkag mus rau lawv lub chaw kho hniav mobile daim ntawv tso cai tus lej uas tau muab los ntawm Pawg Saib Xyuas Kev Kho Hniav ntawm California thiab xa ib daim qauv tsim nyog;
- Txuas lawv lub tsheb DMV rau npe, raws li txoj cai; thiab
- Txuas lawv cov ntawv pov hwm tsheb, raws li txoj cai.
- Sau npe Cov Kws Kho Hniav Hniav nyob rau hauv Kev Ua Lwm Yam
Cov kws kho hniav uas tau sau npe rau hauv lwm qhov kev coj ua uas muaj chaw ua haujlwm uas lawv pom cov neeg mob yuav tsum ua kom tau raws li qhov chaw tsim khoom lag luam raws li California Txoj Cai Tswjfwm Ntiag Tug, Title 22, Tshooj 51000.60.
Tsis tas li ntawd, cov kws kho hniav sau npe hauv lwm qhov kev coj ua uas muab kev pabcuam nkaus xwb ntawm cov chaw nyob, qhov chaw nyob ntawm lub tsev, pawg tsev, cov tsev kho mob tau tso cai, lossis raws li kev tso cai los ntawm Kev Lag Luam thiab Kev Ua Haujlwm (B&P) Code, Tshooj 1925 thiab 1926, tsis tas yuav tsum tau ua kom tau raws li qhov chaw tsim khoom lag luam uas yuav tsum tau muab kev pabcuam rau cov neeg mob. Cov chaw muab kev pabcuam no tuaj yeem tso npe siv qhov chaw nyob tswj hwm raws li lawv qhov chaw nyob thiab tuaj yeem thov kev zam rau qee qhov chaw tsim khoom lag luam uas yuav tsum tau ua los ntawm kev xa cov ntawv pov thawj uas tau teev tseg hauv cov ntawv xov xwm hauv qab no.
In addition, registered dental hygienists in alternative practice are permitted the use of a cellular telephone as the primary business phone. Details on the requirements and procedures for this type of enrollment are outlined in the regulatory provider bulletin titled, “Updated Requirements and Procedures for the Enrollment of Medi-Cal Dental Providers.”
Daim ntawv tso cai
Prior to applying to Medi-Cal, first check the Dental Board to ensure you meet all of the licensing requirements shown under the tab, “Licensees”.
Cov ntaub ntawv xav tau
- Tam sim no California Kev Kho Hniav, Sau Npe Kho Hniav Hniav, Sau Npe Kho Hniav Hniav hauv Lwm Txoj Kev Ua Haujlwm, thiab Sau Npe Kho Hniav Hniav hauv Kev Ua Haujlwm Ntxiv Daim Ntawv Tso Cai ntawm tus neeg thov lossis tus kws kho mob. Thov nco ntsoov cov kws kho mob sab nraud yuav tsum tau muab ib daim ntawv theej ntawm lawv daim ntawv tso cai ua haujlwm rau lawv lub xeev.
- Driver’s License or state-issued identification card (issued within the 50 United States or the District of Columbia) of the provider, or person signing the application who has the authority to legally bind the applicant or provider.
- Federal Employer Identification Number (FEIN) verification, by submitting a current Internal Revenue Service (IRS) generated document. The only acceptable documents include an IRS-generated Letter 147-C, IRS-generated Form 941 (Employer’s Quarterly Federal Tax Return), IRS-generated Form 8109-C (Deposit Coupon), or IRS-generated Form SS-4 (only the official Confirmation Notification of FEIN/ITIN assignment). Note: The legal name of the applicant or provider on the application must match the name on the IRS-generated document. For further information, please visit the IRS or call them at (800) 829-4933.
- Local Business License, Tax Certificate, and Permit for any city and/or county where business activities are conducted. Note: The name and business address of the applicant or provider on the application must match the business name and business address on all local licenses and permits. For further information, please contact your city business license office and/or visit the California State Association of Counties Web Site and click on the “California’s Counties” link, and select “County Web Sites.”
- Recorded/stamped Fictitious Business Name Statement (FBNS), issued by the county where the principal place of business is located, if using a fictitious business name AND the business name is different from the legal name on your application. For example, in the case of a corporation, any name other than the corporation name on record with the Secretary of State requires a FBNS. Note: The business name and business address of the applicant or provider on the application, all local business licenses/permits, and the FBNS must match. To determine the applicable county agency where fictitious business names are filed, please visit the California State Association of Counties Web Site and click on the “California’s Counties” link, and select “County Web Sites.”
- Daim Ntawv Pom Zoo Lub Npe (FNP), muab los ntawm pawg thawj coj saib xyuas tsim nyog (xws li Dental Board of California thiab Dental Hygiene Board of California), yog tias muaj. Txhawm rau txiav txim siab seb FNP puas siv tau, thov mus saib hauv Dental Board of California los yog Dental Hygiene Board of California lub vev xaib.
- Seller’s Permit issued by the California State Board of Equalization, if applicable. Note: The business name and business address of the applicant or provider on the application must match the business name and business address on the seller’s permit. For further information, call the Board of Equalization at (916) 445-6362 or visit their Web Site.
- Ua tiav Daim Ntawv Pom Zoo Kev Sib Koom Tes thiab Kev Hloov Kho, yog tias koj lub lag luam yog kev koom tes. Kev ua haujlwm qeeb yuav raug zam los ntawm kev qhia seb lub koom haum puas yog General Partnership lossis Limited Partnership thiab tseem xa cov hauv qab no:
- Rau Kev Koom Tes Sib Koom Tes, ib daim ntawv teev npe ntawm txhua tus neeg koom tes nrog feem pua ntawm cov tswv cuab lossis tswj kev txaus siab rau txhua tus; los yog
- Rau Kev Koom Tes Ua Lag Luam Limited, cov ntaub ntawv txheeb xyuas Tus Neeg Koom Tes General thiab cov npe ntawm txhua tus neeg koom tes nrog feem pua ntawm cov tswv cuab lossis tswj cov paj laum rau txhua tus.
- To verify or change the name and/or status of your partnership or for further information, please visit the Secretary of State California Business Portal and click on the “California Business Search” link or other appropriate link.
- Articles of Incorporation, if your business is a corporation. For further information, please visit the Secretary of State California Business Portal and click on the “California Business Search” link or other appropriate link.
- Certificate of Commercial Liability Insurance (business, general, or comprehensive liability, or office premises insurance) in an amount of not less than $100,000 per claim and a minimum annual aggregate of $300,000, unless applying for specialized enrollment (see Specialized Enrollment section above for more detailed information). Acceptable verification is either evidence of being self-insured, or a certificate of insurance or declaration sheet issued by the insurance company that contains the name of the insurance company, the name and business address of the insured, effective dates, and limits of coverage. Note: The name and business address, including suite number if applicable, of the applicant or provider on the application must match the insured’s name and address on the certificate of insurance or declaration sheet.
- Certificate of Professional Liability Insurance in an amount of not less than $100,000 per claim and a minimum annual aggregate of $300,000. Acceptable verification is a certificate of insurance or declaration sheet issued by the insurance company that contains the name of the insurance company, the name of the insured, effective dates, and limits of coverage. Note: The provider’s name, as it appears on the professional license, must also show on the verification of the professional liability insurance.
- Certificate of Workers’ Compensation Insurance is required by California law, if your business has one or more employees, unless applying for specialized enrollment (see Specialized Enrollment section above for more detailed information). Acceptable verification is either evidence of being self-insured, or a certificate of insurance or declaration sheet issued by the insurance company that contains the name of the insurance company, the name and business address of the insured, and effective dates. If no Workers’ Compensation insurance is required, an explanation must be provided. Note: The name of the applicant or provider must match the insured’s name on the certificate of insurance.
- Signed Lease Agreement, if business premises are not owned by the applicant or provider, unless applying for specialized enrollment (see Specialized Enrollment section above for more detailed information). Note: The name and business address of the applicant or provider must match the lessee’s name and address on the lease agreement.
- Successor Liability with Joint and Several Liability Agreement (DHCS 6217), if applicable.
- Cov ntaub ntawv ntxiv rau Kev Sau Npe Tshwj Xeeb
- Facility-Based Dental Provider Enrollment
Cov chaw zov me nyuam yuav tsum tau qhia nyob rau hauv daim ntawv thov e-Form tias lawv tab tom thov kev tso npe ua tus kws kho mob hauv chaw kho mob thiab xa cov ntawv pov thawj uas tau teev tseg hauv cov ntawv xov xwm hais saum toj no.
- Kev Sau Npe Rau Tsev Kawm Ntawv Tus Kws Kho Hniav
Cov chaw zov me nyuam hauv tsev kawm ntawv yuav tsum tso npe siv lub tsev kawm ntawv qhov chaw nyob ua lawv qhov chaw nyob, qhia hauv daim ntawv thov e-Form tias lawv tab tom thov ua tus muab kev pabcuam hauv tsev kawm ntawv thiab xa daim ntawv cog lus kos npe ntawm lub tsev kawm ntawv thiab tus kws kho mob.
- Mobile Dental Clinic Sau npe
Cov chaw kho mob txawb yuav tsum tau qhia tias lawv tab tom thov rau npe ua lub chaw kho hniav mobile hauv daim ntawv thov e-Form. Cov neeg muab kev pabcuam no tseem yuav tsum tau:
- Nkag mus rau lawv lub chaw kho hniav mobile daim ntawv tso cai tus lej uas tau muab los ntawm Pawg Saib Xyuas Kev Kho Hniav ntawm California thiab xa ib daim qauv tsim nyog;
- Txuas lawv lub tsheb DMV rau npe, raws li txoj cai; thiab
- Txuas lawv cov ntawv pov hwm tsheb, raws li txoj cai.
- Sau npe Cov Kws Kho Hniav Hniav nyob rau hauv Lwm Txoj Kev Xyaum Sau Npe
Cov kws kho hniav sau npe rau hauv lwm txoj kev coj ua uas muab kev pabcuam nkaus xwb ntawm cov chaw nyob, qhov chaw nyob ntawm lub tsev, cov tsev pab pawg, cov chaw kho mob muaj ntawv tso cai, lossis raws li tau tso cai los ntawm B&P Code, Tshooj 1925 thiab 1926, tuaj yeem tso npe siv qhov chaw nyob hauv chaw tswj xyuas raws li lawv qhov chaw nyob thiab tuaj yeem thov rau kev zam ntawm kev ua lag luam los ntawm qee qhov kev cai tsim tawm. cov ntawv xov xwm hais txog tus kws kho mob.
PAUB Portal
Proceed to the PAVE portal.