To make certain that it meets the requirements of the new state law and that its performance measures are accurate, Health Care Services should do the following: require that the provider field in its data systems be populated in all circumstances.
DHCS has implemented the recommendation, which requires rendering provider identification for every adjudicated claim service line submitted to the Medi-Cal Dental Program. A provider bulletin was released in November 2015 to communicate the changes to the provider community for the December 1, 2015 implementation date.
In a November 2015 Denti-Cal Bulletin, Health Care Services required rendering providers to include their National Provider Identifier number on all dated procedures submitted for payment.
The Department of Health Care Services (DHCS) has drafted a Dental Operating Instruction Letter (DOIL) for its Fiscal Intermediary (FI) to implement the recommendation to require rendering provider ID for every adjudicated claim service line submitted to the Medi-Cal Dental Program. The FI is currently assessing the system impact for the revisions the program seeks to implement. By September 2015, when the system assessment of this effort is complete, an implementation date will be established.
DHCS is currently evaluating whether this can be done within the existing contract or if this requires a new Request for Proposal. Once DHCS has completed the assessment, DHCS can establish a completion date.
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