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Washington State Dental Association

HCA External Review

Attention Medicaid Providers! The Washington State Health Care Authority (HCA) will be conducting an external review of dental-related services and is requesting provider feedback. 

The HCA is amending the following rules in order to add a cross-reference in regards to documentation of client’s dental records, to clarify limitations of covered services, and to clarify the time period that an authorization is valid:

  • WAC 182-535-1079 Dental-related services – General
  • WAC 182-535-1080 Dental-related services – Covered – Diagnostic
  • WAC 182-535-1082 Dental-related services – Covered – Preventative services
  • WAC 182-535-1084 Dental-related services – Covered – Restorative services
  • WAC 182-535-1088 Dental-related services – Covered – Periodontic services
  • WAC 182-535-1090 Dental-related services – Covered – Prosthodontics (removable)
  • WAC 182-535-1092 Dental-related services – Covered – Maxillofacial prosthetic services
  • WAC 182-535-1094 Dental-related services – Covered – Oral and maxillofacial surgery services
  • WAC 182-535-1098 Dental-related services – Covered – Adjunctive general services
  • WAC 182-535-1099 Dental-related services for clients of the developmental disabilities administration of the department of social and health services
  • WAC 182-535-1220 Obtaining prior authorization for dental-related services

Please review the draft changes, make any comments directly on the draft and return to Katie Pounds, Rules & Publications Program Manager, at katherine.pounds@hca.wa.gov or by fax to (360) 586-9727 by close of business on July 6, 2016

All policy questions should be sent directly to Dianne Baum at dianne.baum@hca.wa.gov and cc’d to Katie Pounds at katherine.pounds@hca.wa.gov

Provider Guide Update

The HCA recently published updates to the following Washington Apple Health provider guide:

Dental-Related Services Provider Guide

All of the changes which have been made are listed at the beginning of each provider guide under the “What has changed?” table. The majority of the changes made this quarter are general housekeeping items. 

Please note that the HCA also recently updated the Dental Program Fee Schedule.

All updates and changes to Washington Apple Health Provider Guides and Fee Schedules are made quarterly (January 1st, April 1st, July 1st, & October 1st). 

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TAGGED: Regulatory HCA