Provider Alert

Dear Orthodontic provider, 

Effective immediately for all orthodontic providers submitting a prior authorization request using the General Information for Authorization form (HCA 13-835): do not put any information in field 26 (Tooth or Quad #) unless the agency’s Orthodontic Services Provider Guide requires specific information to be entered.

Please do not reply directly to this message. If you have feedback or questions, please visit the HCA website for contact information.

About Washington State Health Care Authority
HCA oversees the state’s top two health care purchasers — Washington Apple Health (Medicaid) and the Public Employee Benefits Board Program. We work with partners to help ensure Washingtonians have access to better health and better care at a lower cost. For more information, visit www.hca.wa.gov.