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Washington State Dental Association

Medicaid Claim Form Updates

Attention Medicaid Providers: Effective November 1, 2014, the Washington State Health Care Authority (HCA) will only accept dental paper claims submitted on the new ADA paper claim form (version 2012). The HCA plans to begin accepting the new ADA paper claim form by October 19, 2014 and will be accepting both the 2006 and 2012 version until November 1, 2014.

Also effective November 1, 2014, the HCA will no longer accept the old CMS 1500 paper claim form (version 08/05) and will only accept claims on the new CMS 1500 paper claim form (version 2/12).

Please note that the HCA will not return claims submitted on outdated ADA or CMS 1500 paper claim forms on and after November 1, 2014.

Please contact Emily Lovell at should you have any questions. 

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