牙科应用信息
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.”
自 10 月31至2022起，DHCS 不再接受来自牙科服务提供商的纸质申请。
牙科服务提供者包括执业牙医、注册牙科保健员、注册替代执业牙科保健员以及注册扩展职能牙科保健员。 但是，牙科助理、注册牙科助理或具有扩展职能的注册牙科助理无权直接加入 Medi-Cal 或向其收取费用。
PAVE 牙科供应商资源
牙科服务提供商的申请要求
所有申请加入、更改加入或继续加入 Medi-Cal 收费服务计划的牙科申请人均须通过 PAVE 在线系统提交电子表格（可在PAVE网站上获取）。
首选临时提供商资格
有执照的牙医可以请求并提供文件和证明，以考虑作为首选临时提供者加入 Medi-Cal 计划。 首选临时提供商身份将 DHCS 回复的截止日期从 180 天缩短至 150 天。 但是，仍需满足所有计划要求。 如果以下所有陈述都成立，则可能满足优先状态：
- 申请人持有加州牙科委员会颁发的有效牙医执照，该执照没有被吊销、暂缓或受到其他限制；
- 申请人目前已在根据 1975 年诺克斯-基恩医疗保健服务计划法案颁发许可的医疗保健服务计划中注册为牙科服务提供者；
- 申请人的加州医疗补助计划 Medi-Cal Dental 特权从未被撤销和/或暂停；并且
- 申请人在医疗保健诚信和保护数据库/国家执业医师数据库（HIPDB/NPDB）中没有任何不利记录。
大学入学
大学提供者是经认可的大学牙科学校。 这些提供者必须在电子表格申请中表明他们是作为大学提供者提出申请，并上传教职许可证或大学任命牙科主任的信函。
提供医生注册
为牙科服务提供商团体提供服务的医生必须以提供服务提供者的身份提交电子表格申请，将其与牙科服务提供商团体联系起来，并须附上有效的医生/外科医生执照以及有效的全身麻醉许可证。
专门招生
- 机构内牙科服务提供商注册
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.
- 学校牙科服务提供者注册
校本服务提供者在校园内为小学生、初中学生或高中学生提供服务。 这些提供商必须使用学校地址作为其服务地址进行注册，在电子表格申请中表明他们以学校提供商的身份进行申请，并上传学校与提供商之间签署的合同。
- 流动牙科诊所注册
流动诊所必须在电子表格应用程序中表明他们正在申请注册为流动牙科诊所。 这些提供商还必须：
- 输入加州牙科委员会颁发的流动牙科诊所许可证号码并附上清晰的副本；
- 根据法律要求，附上车辆机动车管理局登记证件；以及
- 根据法律要求，附上车辆保险。
- 替代执业注册牙科保健师
拥有为患者看诊的办公室的注册替代执业牙科保健师必须符合《加州法规》第 22 篇第 51000.60 节规定的既定营业地点要求。
另外，仅在居住设施、居家住所、集体住宅、持牌医疗机构或《商业和职业 (B&P) 法典》第 1925 和 1926 条允许的其他场所提供服务的注册牙科保健师，无需满足指定的既定营业地点要求即可为患者提供服务。这些提供商可以使用行政位置地址作为其服务地址进行注册，并且可以通过提交以下提供商公告中概述的证明来申请豁免某些既定营业地点的要求。
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.”
许可
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”.
所需文件
- 申请人或提供者的当前加州牙科、注册牙科保健师、替代实践注册牙科保健师以及扩展职能注册牙科保健师许可证。 请注意，州外服务提供商需要提供其所在州适用的专业执照副本。
- 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.”
- 如果适用，由适当的委员会（例如，加州牙科委员会和加州牙科卫生委员会）颁发的虚拟名称许可证 (FNP)。 要确定 FNP 是否适用，请访问 加州牙科委员会 或者 加州口腔卫生委员会 网站。
- 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.
- 如果您的企业是合伙企业，则需要完全执行合作协议和修正案。 可以通过指明实体是普通合伙企业还是有限合伙企业并提交以下文件来避免处理延迟：
- 对于普通合伙企业，需提供所有合伙人的名单，以及每个合伙人的所有权或控制权百分比；或
- 对于有限合伙企业，提供识别普通合伙人的信息以及所有合伙人的名单，以及每个合伙人的所有权或控制权百分比。
- 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.
- 专门入学附加文件
- 机构内牙科服务提供商注册
基于设施的提供商必须在电子表格申请中表明他们正在申请注册为基于设施的提供商，并提交上述提供商公告中概述的证明信。
- 学校牙科服务提供者注册
校本服务提供者必须使用学校地址作为其服务地址进行注册，在电子表格申请中注明他们以校本服务提供者的身份进行申请，并上传学校与提供者之间签署的合同。
- 流动牙科诊所注册
流动诊所必须在电子表格应用程序中表明他们正在申请注册为流动牙科诊所。 这些提供商还必须：
- 输入加州牙科委员会颁发的流动牙科诊所许可证号码并附上清晰的副本；
- 根据法律要求，附上车辆机动车管理局登记证件；以及
- 根据法律要求，附上车辆保险。
- 注册牙科保健师替代实践注册
仅在住宅设施、居家住所、集体住宅、持牌医疗机构或 B&P 法典第 1925 和 1926 条允许的其他场所提供服务的注册替代执业牙科保健师，可使用行政位置地址作为其服务地址进行注册，并可通过提交上述提供商公告中概述的证明申请豁免某些既定营业地点的要求。
PAVE 门户
Proceed to the PAVE portal.