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Washington State Dental Association

HCA Provider Alert - 2/8/17

Medicaid providers, please note recent HCA provider alerts regarding prior authorization requests for extractions and orthodontic services.

Update for Submitting Prior Authorization Requests for Extractions

In order to correctly process prior authorization (PA) requests for extractions, providers must list the appropriate CDT code along with the tooth/teeth number(s) on the General Information for Authorization form (HCA 13-835). Add this information to each individual line for each individual tooth number (boxes 20-26) on the HCA 13-835 form, or add it to box 30 of the HCA 13-835 form.

Effective for prior authorization requests received on and after February 1, 2017, the Health Care Authority (agency) will reject all PA requests for extractions that do not indicate the tooth/teeth number(s) on the HCA 13-835 form. The rejected PA requests must be corrected and resubmitted to agency.

The agency has updated the Dental-Related Services Billing Guide, dated January 1, 2017, to reflect this information. 
Preproposal - Notice of Intent (CR101)

Chapter 182-535 WAC, Dental-related services and Chapter 182-535A WAC, Orthodontic services (WSR 17-04-099). 

The agency is amending Chapter 182-535 WAC, Dental-related services, and Chapter 182-535A WAC, Orthodontic services, to clarify or change coverage limits and to remove some prior authorization requirements.

Please contact the HCA with any questions.

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