Prior authorization requirement for replacement dentures

Washington State Health Care Authority sent this bulletin at 07/27/2021 03:54 PM PDT

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Apple Health (Medicaid) Provider Alert

Attention Dental providers:

Effective for claims with dates of service on and after August 2, 2021, all replacement dentures will be subject to prior authorization regardless of whether five years have passed or not. Prior authorization is required for all replacement dentures along with evidence of medical necessity.

This change aligns with revised WAC 182-535-1090 Dental-related services – Covered – Prosthodontics (removable), effective August 2, 2021.

About the Health Care Authority (HCA)

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, the School Employees Benefits Board (SEBB) Program, and the COFA Islander Health Care 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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Nondiscrimination

The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.

Prior authorization requirement for replacement dentures

Apple Health (Medicaid) Provider Alert

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About the Health Care Authority (HCA)

Disclosure notice

Nondiscrimination