牙科申請資訊
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 , 2022起，DHCS 不再接受牙科服務提供者的紙本申請。
牙科提供者包括持牌牙醫、註冊牙科衛生師、註冊牙科衛生專員、替代診所的註冊牙科衛生師，以及具有擴展職能的註冊牙科衛生師。 但是，牙科助理、註冊牙科助理或擴展職能的註冊牙科助理無權直接參加加州醫療補助健康保健計劃或直接開立帳單。
PAVE 的牙科提供者資源
牙科提供者的申請要求
所有要求註冊、更改註冊或繼續註冊Medi-Cal Fee-for-Service專案的牙科申請人必須透過 PAVE 線上系統（可在PAVE網站上取得）提交電子表格。
首選臨時提供者資格
持牌牙醫可以要求並提供文件和驗證以考慮註冊 Medi-Cal 計劃作為首選臨時提供者。 首選臨時提供者狀態可將 DHCS 回應的截止日期從 180 天縮短為 150 天。 但是，仍需要滿足所有程序要求。 如果以下所有陳述都是真的，則可能會達到偏好狀態：
- 申請人持有由加州牙科委員會頒發的現行牙醫執照，該執照未被吊銷（無論是否暫停）、暫停、緩刑或受到其他限制；
- 申請人目前已通過根據 1975 年諾克斯-基恩醫療保健服務計劃法授權的醫療保健服務計劃註冊為牙科提供者；
- 申請人從未透過加州醫療補助健康保健計劃牙科撤銷和/或暫停特權；和
- 申請人在醫療保健誠信和保護數據庫/國家從業人數據庫（HIPDB/NPDB）中沒有任何不良條目。
大學入學
大學提供者是認可的大學牙科學校。 這些提供者必須在電子表格申請表中註明他們是以大學提供者身份申請，並上傳教師許可證或大學委任牙科主任的信件。
呈現醫生註冊
為牙科提供者群體提供服務的醫生必須以提交電子表格申請，作為轉譯提供者與牙科提供者群組連結，並且必須附上有效的醫生/外科醫生執照以及有效的醫療全身麻醉許可證。
專業報名
- 基於設施的牙科提供者註冊
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.
- 校本牙科提供者註冊
基於學校的提供者為學校園內的小學、中學或高中學生提供服務。 這些提供者必須使用學校地址作為服務地址註冊，在電子表格申請表中註明他們是以學校為基礎提供者的身份申請，並上傳學校與提供者之間簽署的合同。
- 移動牙科診所報名
流動診所須在電子表格申請表中表示他們正在申請註冊為流動牙科診所。 這些提供者還需要：
- 輸入加州牙科委員會頒發的流動牙科診所許可證號碼並附上清晰的副本；
- 根據法律要求附上其車輛 DMV 登記；及
- 根據法律要求附上他們的車輛保險。
- 替代診所的註冊牙科衛生專員
根據《加州法規》第 22 章第 51000.60 節的規定，擁有辦公室為患者看診的註冊牙科保健員必須滿足規定的營業地點要求。
另外，只在住宅設施、家居住所、團體住所、持牌健康設施或商業 (B & P) 條第 1925 及 1926 條允許的註冊牙科衛生專員，則不需要符合指定的經營地點要求，才能向患者提供服務。這些供應商可以使用管理位置地址作為其服務地址註冊，並可以提交下面提供者公告中所述的證明，以申請特定已確定的營業地點要求豁免。
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.”
授權
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
- 申請人或提供者的當前加州牙科、註冊牙科保健員、替代實踐註冊牙科保健員和擴展功能註冊牙科保健員許可證。 請注意，州外提供商將需要提供適用於其州的專業執照副本。
- 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.”
- 假名許可證 (FNP)，由適當的委員會（例如，加州牙科委員會和加州牙科衛生委員會）頒發（如果適用）。 若要確定 FNP 是否適用，請瀏覽 加州牙科委員會 或者 加州牙科衛生委員會 網站。
- 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.
- 如果您的業務是合作夥伴關係，則完全執行的合作協議和修訂。 透過指出實體是一般合夥企業或有限合夥人，並提交以下事項，可以避免處理延誤：
- 對於一般合夥人，所有合夥人的清單，其中包含每個合夥人的所有權或控制權益百分比；或
- 對於有限合夥人，指定一般合夥人的資訊，以及所有合夥人清單，其中包含每個合作夥伴的所有權或控制權益百分比。
- 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.
- 專業註冊的其他文件
- 基於設施的牙科提供者註冊
基於設施的提供者必須在電子表格申請中註明他們正在申請成為基於設施提供者的註冊，並提交上述提供者公告中所述的證明信。
- 校本牙科提供者註冊
學校服務提供者必須使用學校地址作為服務地址註冊，在電子表格申請中註明他們是以學校為基礎提供者的身份申請，並上傳學校與提供者之間簽署的合同。
- 移動牙科診所報名
流動診所須在電子表格申請表中表示他們正在申請註冊為流動牙科診所。 這些提供者還需要：
- 輸入加州牙科委員會頒發的流動牙科診所許可證號碼並附上清晰的副本；
- 根據法律要求附上其車輛 DMV 登記；及
- 根據法律要求附上他們的車輛保險。
- 註冊牙科衛生專員（替代診所）報名
註冊牙科衛生專員只在住宅設施、家居住所、團體住所、持牌健康設施或在 B & P 條第 1925 及 1926 條允許的情況下提供服務服務，可以使用行政地址作為服務地址註冊，並可以提交上述供應商公告所載的證明申請豁免。
鋪路門戶
Proceed to the PAVE portal.