HCA Provider Alert

Dental Medicaid

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Latest Medicaid News

HCA Provider Alert

The Washington State Health Care Authority (HCA) recently sent a provider alert regarding changes to prior authorization requests for photographs and radiographs (x-rays).

Dental-Related Services 

Effective immediately, all photographs and radiographs (x-rays) submitted with prior authorization requests must be current images that were taken within the past 12 months per WAC 182-535-1220 (2): 

“The agency requires a dental provider who is requesting prior authorization to submit sufficient, current (within the past twelve months), objective clinical information to establish medical necessity.” 

All images must have the client name and date of birth or the ProviderOne Client ID number, and must include the date the images were taken. The Dental-Related Services Billing Guide was updated on July 1, 2017, to reflect this requirement.  If the images are not current, within the last twelve months, the agency will reject the prior authorization request, and the request must be resubmitted with current images.   

Orthodontic Services

Effective immediately, all photographs submitted with prior authorization requests for orthodontic services must be submitted on one sheet of 8.5 X 11-inch paper. Fill the photograph page as fully as possible. Position the photographs on the page as follows: 
  • Top row: facial views 
  • Middle row: occlusal views with the client’s name and date of birth, the provider information, and the date of imaging between the two photographs 
  • Bottom row: three-teeth-together views   

To match the orientation of the occlusal views to the client’s left and right side of their face: 

  • Print the right-side view on the left of the sheet
  • Print the left-side view on the right side of the sheet

This format follows the requirements of the American Board of Orthodontics and the orthodontic departments at the University of Washington and University of Oregon. The Orthodontic Services Billing Guide was updated on January 1, 2015, to reflect this requirement.

Medicaid Transition to Managed Care Cancelled

The 2019 Legislature has directed the Washington State Health Care Authority (HCA) to continue to administer the dental Medicaid program through fee-for-service. The HCA may not proceed with a carved-out or carved-in managed care dental option at this time.

Learn More

Questions? Please email info@wsda.org.