​​​Dental Authorizations & Claims

Dental/Orthodontic Authorization Process

Claims Processing

Billing Questions​​

Dental/Orthodontic Authorization Process

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.

Some helpful tips when submitting a dental/orthodontic SAR:

• 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.
• All dental/orthodontic SARs are issued pending review by Medi-Cal Dental/Delta Dental for authorization.
• Medi-Cal Dental will not authorize any procedures for CCS without a matching SAR.
• 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).  
• All orthodontic services require prior authorization from Medi-Cal Dental. 

Claim​s Processing

Claims for services that have been authorized by CCS or Medi-Cal Dental are to be submitted directly to Medi-Cal Dental.

• Submit claims for services that were approved or authorized by the CCS program or Medi-Cal Dental. Claims for services without CCS or Medi-Cal Dental approval or prior authorization may be denied.
• Submit claims for services rendered to a client confirmed eligible to receive CCS benefits. Claims for services rendered to clients who are not CCS or are no longer eligible to receive CCS benefits will be denied.
• Submit claims to Medi-Cal Dental in a timely manner.

Submit claims for services rendered to clients with other health insurance coverage with the Explanation of Benefits (EOB) attached to the claims.

Billing Questions

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.