EDI
Introduction
Electronic Data Interchange or EDI is a quick, efficient method of transmitting data to Denti-Cal via your computer. Eliminating hardcopy submission of data can save money on your practice resources and reduce the rate of document errors. That's why participating EDI providers experience improved cash flow, a marked decrease in paperwork, and more efficient use of office staff.
Overview of EDI
Denti-Cal's EDI service is an optional method of data submission available to all participating Denti-Cal providers. EDI is an easy, efficient, paperless system that uses telephone lines to transmit information from your office's computer to Denti-Cal, and transmit information back from Denti-Cal to your computer.
Providers using EDI may electronically transmit the following document types:
- Claim
- Claim Adjustment
- Treatment Authorization Request (TAR)
- Notice of Authorization (NOA)
Technical Specifications
All documents submitted electronically must be compliant with the applicable transaction standard. Requirement guidelines for the EDI X12 transactions are explained in the X12 Technical Report Type 3 (TR3) documents (previously referred to as Implementation Guides), published by Washington Publishing Company (WPC). TR3s are available on the WPC web site (wpc-edi.com).
Below is a link to the Denti-Cal EDI (Electronic Data Interchange) Companion Guide that includes 5010 Transaction Guides addressing the 837D (Health Care Claim: Dental), 835 (Health Care Claim Payment/Advice), 276 (Health Care Claim Status Request), and 277 (Health Care Claim Status Response) transactions. Denti-Cal's Transaction Guides highlight only information specific to the Denti-Cal program and must be used in conjunction with the applicable TR3.
EDI trading partners wishing to submit directly to Denti-Cal are required to first undergo testing and certification. For information, please send an email to denti-caledi@delta.org or call (916) 853-7373 and ask for EDI Support.
In this area of the Medi-Cal Dental Program web site, providers can view or download the following:
- EDI Savings Calculator
- Denti-Cal Electronic Data Interchange (EDI) How-To Guide Revised April 2016
- HIPAA Transaction Standard Companion Guide [Denti-Cal EDI (Electronic Data Interchange) Companion Guide]
EDI Enrollment Application Packet
The EDI Enrollment Application Packet includes all forms noted under EDI Enrollment Application Forms.
EDI Enrollment Application Forms
If you need specific enrollment application forms. (Key: 
Online-Fillable)
- Cover Sheet (general instructions for completing forms)
- EDI Enrollment Application (Rev. 0611)
- Electronic Remittance Advice (ERA) Enrollment Form
- Provider Service Office EDI Option Selection Form
- Forms Reorder Request (Rev. 1115)
- Title 22 Language Pertaining to EDI (Rev. 0407)
(Title 22, Division 3, Chapter 3, Article 7, Section 51502.1 Requirements for Electronic Claims Submission)