Claim Attachment Cover Sheets Updated

Dental Medicaid

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Latest Medicaid News

Claim Attachment Cover Sheets Updated

Please read the following message from the HCA: 

Claim attachment cover sheets updated

To simplify your claim processes, we reduced the number of claim attachment cover sheets from five to two.

What's changed?

We have replaced the following four cover sheets:

  • Electronic claim backup (ECB) attachments
  • UB-04 attachments (when supporting documents are detached from original claim)
  • CMS-1500 attachments (when supporting documents are detached from original claim)
  • ADA 2006 dental attachments

With a single-use form:

Use this form when sending all supporting documents to a non-pharmacy claim.

Has the pharmacy claim attachment changed?

No. There is no change to the pharmacy claim attachment.

Where do I find these cover sheets?

All cover sheets are available on our Document submission cover sheets 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