The Health Care Authority (HCA) recently sent the following alert to dental Medicaid providers.
Prior authorization requirement for replacement dentures
Effective for claims with dates of service on and after August 2, 2021, all replacement dentures will be subject to prior authorization regardless of whether five years have passed or not. Prior authorization is required for all replacement dentures along with evidence of medical necessity.
This change aligns with revised WAC 182-535-1090 Dental-related services – Covered – Prosthodontics (removable), effective August 2, 2021.