Apple Health: Update to Orthognathic prior authorization requests

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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.