Washington State Health Care Authority sent this bulletin at 03/24/2017 03:46 PM PDT
Apple Health (Medicaid): Provider Alert
This alert is a follow-up message to an alert issued on January 3,
2017.
In order to correctly process prior authorization (PA)
requests for orthodontic treatment, the Health Care Authority (agency) revised
the Orthodontic Information form (HCA 13-666).
Effective for dates of service on and after April 1, 2017,
providers must use the updated Orthodontic Information form (HCA 13-666) for
orthodontic treatment PA requests. HCA 13-666 must be submitted in addition to
the General Information for Authorization form (HCA 13-835). The agency will
reject all PA requests for orthodontic treatment that are not submitted on the
revised form.
Part II, #3, of the updated form requires the provider to
submit a colored photograph if the client has an overjet greater than 9mm with
incompetent lips, or a reverse overjet greater than 3.5mm with reported
masticatory and speech difficulties.
The updated form is available for download on the agency’s Forms & publications web page and can be
used immediately.
Please do
not reply directly to this message. If you have feedback
or questions, please visit the HCA
website for contact information.
About
WashingtonStateHealth 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.