Apple Health: Update to Orthognathic prior authorization requests

Washington State Health Care Authority sent this bulletin at 09/28/2017 01:59 PM PDT

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Apple Health (Medicaid) Provider Alert

Effective for claims with dates of service on and after October 1, 2017, prior authorization (PA) requests for orthognathic surgery must be submitted to the agency at least 12 months after the start of active orthodontic treatment. Previously the agency required the PA request to be submitted six to eight weeks before the surgery date.

The agency will reject PA requests for orthognathic surgery submitted before the client has received 12 months of active orthodontic treatment.

The agency updated the Orthodontic Services Billing Guide, effective October 1, 2017, to reflect this change.

About the Health Care Authority (HCA)

The Washington State Health Care Authority purchases health care for more than 2 million Washington residents through Apple Health (Medicaid) and the Public Employees Benefits Board (PEBB) Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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Apple Health: Update to Orthognathic prior authorization requests

Apple Health (Medicaid) Provider Alert

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About the Health Care Authority (HCA)

Disclosure notice