Denti-Cal was renamed Medi-Cal Dental, but the program underneath it did not change. Claims still run on two separate tracks: Fee-for-Service, which pays from the Schedule of Maximum Allowances, and Dental Managed Care, which operates in select counties and routes through the member’s dental plan. Billing the wrong track is one of the most common reasons a California claim is denied outright, so we confirm the delivery system before anything is submitted.

A Treatment Authorization Request is Medi-Cal Dental’s prior-approval process. Procedures that typically require one include crowns, posterior root canals, periodontal treatment, dentures, and most orthodontic cases, though the list shifts with program updates. An approved TAR also carries its own service window, so we track submission, approval, and expiry alongside the claim instead of treating authorization as a one-time step.

Adult Medi-Cal dental benefits were fully restored in 2018, and the current scope covers exams, radiographs, cleanings, fillings, root canals, crowns, periodontal treatment, and complete dentures. Practices underbill them because internal fee schedules and treatment plans were never updated after restoration, so covered services get quoted as cash or left off the claim entirely. We reconcile what was delivered against what is currently covered before the claim goes out.

Proposition 56 tobacco-tax funding pays supplemental amounts on top of the standard Medi-Cal Dental allowance for a defined set of CDT codes. They pay on qualifying claims rather than being requested separately, which is exactly why they go unnoticed: if the code, provider type, or documentation is off, the base claim still pays and the supplement quietly does not. We reconcile remittances against the qualifying code list so shortfalls surface instead of being written off.

Sacramento and Los Angeles are California’s Dental Managed Care counties. In Sacramento, members are enrolled in a DMC plan by default; in Los Angeles, they choose between DMC and Fee-for-Service. That makes eligibility the deciding factor on every claim, because the plan, the filing window, and the authorization path all change with it. We verify enrollment and delivery system at the appointment, not after a denial.

Share of Cost is the monthly amount certain Medi-Cal members must incur before their coverage begins, much like a deductible, and it resets every month. It has to be cleared and certified in the state system for that month before the claim will pay. Practices lose money by collecting it without certifying it, or by billing before it has been met. We confirm Share of Cost status at verification and sequence the claim once the obligation is satisfied.

Filing windows vary by payer: Medi-Cal Dental runs on a tighter deadline than most commercial plans, and PPO, ERISA, and secondary claims each have their own clock. The losses rarely come from forgetting to file. They come from claims that were filed, denied, then left sitting in A/R while the window closed behind them. We track deadlines by payer, network, and claim type, and work denials against the time that is actually left.