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Getting Enrolled and Staying Enrolled, lesson 1 of 3
Enrolling as a Medi-Cal Dental Provider
Enrollment is mostly a paperwork exercise, and the delays are almost always the same handful of things. Mismatched details across your own documents cause more lost weeks than anything the program does.
- Sort first. Your NPI, your license and your business details all matching
- Biggest delay. The same name or address written two ways
- Plan for. Weeks, not days, and start before you need it
- Check. Current requirements from the program itself
Make Your Own Paperwork Agree With Itself
Your provider number, your state license, your tax registration and your business filing all carry a name and an address. If any two of them disagree, even by a suite number or a middle initial, expect the application to come back.
Fix that before you apply. It is dull, it takes an afternoon, and it is the single highest value thing on this page.
Know Which Thing You Are Enrolling
There is a difference between the person who treats the patient and the entity that gets paid. Practices get this wrong and then wonder why payments do not arrive.
If you have more than one location, or associates, work out who is enrolling as what before you fill anything in. Untangling it afterwards is far more work.
Expect a Site Visit and a Background Check
Screening is part of enrolling, and depending on your category that can include somebody coming to look at the practice. That is normal rather than a sign of suspicion.
Make sure whoever is at your front desk knows it may happen, so a visit is not turned away by a well meaning receptionist.
Give It More Time Than You Think
Plan in weeks. If you are opening a practice, or your current enrolment is lapsing, start well before the date you need it to be live.
Track what you sent and when. When you eventually chase, being able to say exactly what went out on which date is what gets the call moved along.
Enrolment Is Not the End of It
You will need to revalidate, and you have to report changes. A new address, a new owner, a new associate. Practices lose their enrolment through inattention far more often than through anything dramatic.
Put the renewal in a calendar that outlives whoever currently sits at the front desk.
Get the Current Process From the Program
Forms, systems and screening requirements change. Take the current process from the Medi-Cal Dental program and the state's own enrolment system rather than from any summary, this one included.
Before You Spend a Dime
Can we see patients while the application is pending?
Do not assume so. Ask the program what applies to your situation before you treat anybody expecting to be paid for it.
Do associates enroll separately?
Usually the treating provider and the billing entity are handled separately. Confirm which applies to your setup before filing.
What most often causes a rejection?
Inconsistent details between documents, and missing signatures. Both are avoidable in an afternoon.
Next Problem to Solve
- Credentialing Without Losing a Month of ProductionNext in the course. How to run dental credentialing and re-credentialing so a new associate can actually be paid for the work they do.
- Getting Paid by Denti-Cal Without Losing a MonthRelated. How to cut denials on Medi-Cal dental claims, which ones are worth appealing, and the front desk habits that decide both.
- Should Your Practice Take Medi-Cal PatientsRelated. A plain look at the economics of Medicaid dental for a private practice, and how some offices make it work.