A
Is the Pre-Approval of Dental Treatment (pink letter) sent to a member or provider?
A member.
What form notifies a member that their services have been denied, modified or deferred?
Notice of Medi-Cal Dental Action
aka. TARNOT or BeneTARNOT
Where can a member use the pink letter authorization letter they received through a State Hearing?
At any enrolled provider of their choice.
180.
Same as a typical NOA.
Is the pink letter issued by a State Hearing assigned to a specific provider?
No. Members can take their pink letter to any enrolled provider of their choice.
What is the green letter used for?
To retract a state hearing request.
True or False: A member may represent themselves or arrange for someone else to represent them- including friends, lawyers, or anyone else they choose.
True.
True or False: Services allowed through the State Hearing Process do not require a TAR (with one exception).
True.
Where / How can a member file a State Hearing (3 ways)?
Online
In writing
By phone
How long after the date of service does a provider have to bill for treatment allowed by a State Hearing?
6 months.
* This is different than the normal 12 months for other claims/NOAs).
Members have how long after the date on their Notice of Medi-Cal Dental Action to submit a State Hearing Request?
90
True or False: A provider may request a State Hearing if they are unsatisfied with their payment amount.
False
What are the 3 reasons a member might request a State Hearing?
Requested Services were denied or modified
They are unhappy with the results of their complaint
Their Conlan refund request was denied.
What are the 4 Treating Dentist Responsibilities?
Be an enrolled provider
Verify Member's Medi-Cal Eligibility for the month treatment is completed.
Provide Treatment within 180 days of the date on the pink authorization letter.
Submit a claim no more than 6mo after the end of the month the treatment was given *the claim must include the original pink notice.
Before requesting a State Hearing, what should members do if they receive a Notice of Medi-Cal Dental Action denying or modifying requested services?
Discuss different treatment plans with their provider, to get the best care that is covered by Medi-Cal Dental.
True or False: Claims for services allowed through a State Hearing must be sent to a different address than standard claims or NOAs.
True.
To avoid being denied because there is no NOA on file for their office- a provider must mail their claim and the pink authorization letter together for processing by the State Hearing department.