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Washington State Dental Association

HCA Provider Alerts – 5/31 & 6/6

The Washington State Health Care Authority (HCA) recently released the following provider alerts regarding State Maximum Allowable Costs and Orthodontic Information Forms.

5/31: Changes to the State Maximum Allowable Costs (SMAC) list effective July 1, 2017

Washington Apple Health (Medicaid), administered by the Health Care Authority (agency), will implement changes (view here) to the State Maximum Allowable Costs (SMAC) list for the fee-for-service (FFS) Prescription Drug Program.

The full SMAC list can be found on the agency’s Pharmacy Information website and applies to claims billed FFS.

6/6: Updated Orthodontic Information Form (HCA 13-66)

This alert is a follow-up message to an alert issued on March 24, 2017. The most recent version of the Orthodontic Information form (dated 5/17) has some minor changes from the last revision (dated 1/17), including an example form on page 4.

As stated in the previous alert, providers must use the updated Orthodontic Information form (HCA 13-666) for orthodontic treatment prior authorization (PA) requests. HCA 13-666 must be submitted in addition to the General Information for Authorization form (HCA 13-835). The agency will reject all PA requests for orthodontic treatment that are not submitted on the revised form.

The updated form is available for download on the agency’s Forms & Publications web page and should be used immediately.

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