CDA working with Medi-Cal Dental Program to resolve payment delays, other challenges

June 27, 2024
731
Dentist and patient
QUICK SUMMARY: CDA is aware of the challenges some Medi-Cal Dental providers are facing as a result of delayed processing times and backlogs of unpaid claims in the wake of the Change HealthCare cyberattack earlier this year. We are working closely with Medi-Cal Dental to ensure numerous issues are resolved. Find resources and guidance below to help your practice address billing and payment delays now.

CDA is aware of the challenges some Medi-Cal Dental providers are facing as a result of delayed processing times and backlogs of unpaid claims. The cyberattack on Change HealthCare earlier this year created numerous issues with clearinghouses, such as DentalXChange through Henry Schein. These challenges were compounded by the May transition of the Medi-Cal administrator contract from Delta Dental to Gainwell Technologies.

CDA has stayed in close contact with Medi-Cal Dental and is pushing to ensure these issues are resolved as quickly as possible. Medi-Cal Dental representatives assure us they understand the importance of addressing these delays and are working hard to expedite delayed payments. They expect the Gainwell contract, absent the Change HealthCare disruption, to be held to performance standards that will better serve providers and patients. The most recent communications from Medi-Cal Dental to providers ensures their continued commitment to enrollees and providers, and we encourage you to review those communications.

Below are additional resources and information to help practices facing billing and payment delays or challenges:

  • If you are experiencing issues, please call the Medi-Cal Provider line at 800.423.0507. Increased staffing at the call center has significantly decreased wait times.
  • If payment delays are impacting your daily operations, such as causing a financial hardship, you can ask Medi-Cal Dental representatives for “special handling” to elevate your case.
  • For those who are being asked to send paper claims as an interim solution while the clearinghouse issues are resolved, ensure your office provides all required claim fields in the hard-copy documents to prevent delays in processing. If your office has received Resubmission Turnaround Documents, read this document to avoid delays.
  • Refer to the recent DHCS Medi-Cal Dental Provider Bulletin for more information about issues related to Henry Schein and DentalXChange. Henry Schein customers can also call 888.647.2547 for assistance.

With over one-third of Californians, including half of all California children, covered by Medi-Cal Dental, we will continue to work with the Medi-Cal Dental Program to resolve payment delays and other challenging issues so your practice can provide timely care to the Medi-Cal patients you serve. CDA supports our member dentists through advocacy, expertise and resources and will keep you updated on resolutions as information is made available. If your concerns are not being addressed, please reach out to one of CDA’s specialized experts for support.

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