牙科授權 & 索償
牙齒 ／ 矯正授權程序
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 Medi-Cal Dental) 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 Medi-Cal Dental. Only active Medi-Cal Dental 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.
提交牙齒/矯正 SAR 時的一些有用提示：
- 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.
- 所有牙科/牙齒矯正 SARS 均已發出，等待美高牙科/台達牙科審批核准。
- 如果沒有相符的 SAR，Medi-Cal 牙科不會授權任何 CCS 程序。
- CCS follows all of Medi-Cal Dental’s policies, procedures, and requirements.
- Providers should not proceed with treatment until an authorization is received from Medi-Cal Dental (unless Medi-Cal Dental does not require prior authorization for a specific service–see Medi-Cal Dental Provider Manual Section 4, Program Policy).
- 所有牙齒矯正服務均需事先獲得 Medi-Cal Dental 授權。
索賠處理
Claims for services that have been authorized by CCS or Medi-Cal Dental are to be submitted directly to Medi-Cal Dental.
- 提交獲 CCS 計劃或 Medi-Cal Dental 批准或授權的服務申請。 未獲 CCS 或 Medi-Cal Dental 批准或事先授權的服務申請可能被拒絕。
- 向確認有資格獲得 CCS 福利的客戶提交服務索賠。 對於向非 CCS 或不再有資格獲得 CCS 福利的客戶提供的服務的索賠將被拒絕。
- 及時向梅迪卡牙科提交索償。
提交向擁有其他健康保險的客戶提供的服務的索賠，並附上索賠的福利說明 (EOB)。
計費問題
If you have billing questions, please contact Delta Dental at (800) 423-0507. You can also visit the Medi-Cal Dental website for billing procedures and updates.