Apple Health (Medicaid): Provider Alert

Update for Submitting Prior Authorization Requests for Extractions

In order to correctly process prior authorization (PA) requests for extractions, providers must list the appropriate CDT code along with the tooth/teeth number(s) on the General Information for Authorization form (HCA 13-835). Add this information to each individual line for each individual tooth number (boxes 20-26) on the HCA 13-835 form, or add it to box 30 of the HCA 13-835 form.

Effective for dates of service on and after February 1, 2017, the Health Care Authority (agency) will reject all PA requests for extractions that do not indicate the tooth/teeth number(s) on the HCA 13-835 form. The rejected PA requests must be corrected and resubmitted to agency.

The agency has updated the Dental-Related Services Billing Guide, dated January 1, 2017, to reflect this information.

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.