
Get the free Medi-Cal Dental Case Management Referral Form v
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Case Management Referral Form
This form must be completed by the members medical provider, dental provider, caseworker or healthcare
care professional. Members cannot self refer and must meet the
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How to fill out medi-cal dental case management

How to fill out medi-cal dental case management
01
Gather all necessary information about the patient's medical and dental history.
02
Determine if the patient is eligible for Medi-Cal dental case management.
03
Complete the necessary forms and documentation for enrollment.
04
Submit the completed forms and documentation to the appropriate Medi-Cal dental case management provider.
05
Follow up with the provider to ensure enrollment is processed successfully.
06
Provide ongoing support and coordination of dental services for the patient as needed.
Who needs medi-cal dental case management?
01
Individuals who are eligible for Medi-Cal and require dental services may benefit from Medi-Cal dental case management.
02
This can include individuals with complex dental needs, individuals with chronic medical conditions that impact dental health, and individuals who require assistance in navigating the Medi-Cal dental system.
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What is medi-cal dental case management?
Medi-Cal dental case management is a program designed to coordinate dental care for beneficiaries, ensuring they receive appropriate services, referrals, and follow-up to improve oral health outcomes.
Who is required to file medi-cal dental case management?
Providers participating in the Medi-Cal dental program are required to file medi-cal dental case management, particularly when working with patients who have complex dental needs or require special attention.
How to fill out medi-cal dental case management?
To fill out medi-cal dental case management, providers must complete the designated forms provided by the state, accurately documenting the patient's dental history, treatment plans, and any referrals made to specialists.
What is the purpose of medi-cal dental case management?
The purpose of medi-cal dental case management is to enhance access to dental care for low-income individuals, ensuring that they receive timely and effective treatment while managing their overall dental health.
What information must be reported on medi-cal dental case management?
Providers must report patient demographics, the nature of dental issues, treatment provided, referrals made, follow-up actions taken, and any outcomes related to the patient's dental care.
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