Provider Alert: Orthodontic Treatment Payment Methodology Not Changing 7/1/2019

Dental Medicaid

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Provider Alert: Orthodontic Treatment Payment Methodology Not Changing 7/1/2019

Please read the following from the HCA:

The Health Care Authority (HCA) has heard your concerns and is re-evaluating the decision to change the payment methodology for orthodontic treatment provided to Apple Health clients beginning July 1, 2019. Please disregard the Provider Alert sent on June 14, 2019. HCA will not be implementing this change and will not be publishing a revised Orthodontic Services Billing Guide, effective July 1, 2019.

Dental providers should continue billing for orthodontic services as they currently are, using the billing instructions found in the current Orthodontic Services Billing Guide, dated April 1, 2019, found on HCA’s Billers and Providers webpage, under billing guides and fee schedules.

HCA encourages dental providers and billers to sign up to receive early notices of Apple Health rulemaking pertaining to orthodontic services. Sign up for rulemaking notices through HCA’s Rulemaking webpage.

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.

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Questions? Please email info@wsda.org.
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