Apple Health (Medicaid) Provider Alert
Dental-Related
Services
Effective
immediately, all photographs and radiographs (x-rays) submitted with prior
authorization requests must be current images that were taken within the past
12 months per WAC 182-535-1220 (2):
“The agency requires a dental provider who
is requesting prior authorization to submit sufficient, current (within the
past twelve months), objective clinical information to establish medical
necessity.”
All
images must have the client name and date of birth or the ProviderOne Client ID
number, and must include the date the images were taken. The Dental-Related
Services Billing Guide was updated on July 1, 2017, to reflect this
requirement. If the images are not
current, within the last twelve months, the agency will reject the prior
authorization request, and the request must be resubmitted with current images.
Orthodontic
Services
Effective
immediately, all photographs submitted with prior authorization requests for orthodontic
services must be submitted on one sheet of 8.5 X 11-inch paper. Fill the photograph
page as fully as possible. Position the photographs on the page as follows:
-
Top row: facial views
-
Middle row: occlusal views with the client’s name and date of birth, the provider information, and the date of imaging between the two photographs
-
Bottom row: three-teeth-together views
To
match the orientation of the occlusal views to the client’s left and right side
of their face:
- Print the right-side view on the left of the sheet.
-
Print the left-side view on the right side of the sheet.
This
format follows the requirements of the American Board of Orthodontics and the orthodontic
departments at the University of Washington and University of Oregon. The Orthodontic
Services Billing Guide was updated on January 1, 2015, to reflect this
requirement.
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