HCA: Photos required with PA requests for replacement and partial dentures, Eff. 10/15/2021

Dental Medicaid

WSDA is committed to keeping our members up to date on the latest news and information involving Washington state's Dental Medicaid program.

COVID-19: HCA has created a web page ​for COVID-19 information. For Medicaid provider information, scroll down to the "Providers" section.

Latest Medicaid News

HCA: Photos required with PA requests for replacement and partial dentures, Eff. 10/15/2021

The Health Care Authority (HCA) recently sent the following alert to dental Medicaid providers.

Photos required with PA requests for replacement and partial dentures, Eff. 10/15/2021

Effective October 15, 2021, when submitting prior authorization (PA) requests for replacement dentures (CDT® codes D5110/5120) or partial dentures (CDT® codes D5211/D5212), due to wear or breakage, the Health Care Authority (HCA) will require photos of the client’s original (existing) appliance to determine medical necessity.

Before this effective date, all PA requests submitted without photos will be pended back for photos. Starting October 15, 2021, submissions without photos will be rejected and will need to be resubmitted with the required photos.

CDT is copyright © 2020 American Dental Association. All rights reserved. 

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.
ADA
"State":"WA"