Dental-related services - client limit inquiries

Washington State Health Care Authority sent this bulletin at 11/23/2022 04:23 PM PST

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Apple Health (Medicaid) Provider Alert

Attention Dental providers:

The Health Care Authority (HCA) is experiencing an increase in service limit requests for dental-related services through the online webform. As a result, HCA’s responses may take longer than the usual 48 hours.

To streamline the process and help HCA expedite the requests, HCA is asking providers to do the following before submitting client limit inquiries:

Check client eligibility and confirm enrollment in Apple Health/Medicaid
Confirm the client’s benefit service package covers the requested service
Review the appropriate dental billing guide to confirm that:
- The service has limitations
- The service is covered for the client’s age
Do not send duplicate limit inquiry requests
Do not send requests by template. Request only the services that will be performed. Requests submitted by template will not be processed.

Associated guides for dental-related services can be found on the Provider billing guides and fee schedules webpage.

Dental-Related Services
Access to Baby and Child Dentistry (ABCD)
Orthodontic Services
Oral Health Connections

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.

Dental-related services - client limit inquiries

Apple Health (Medicaid) Provider Alert

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About the Health Care Authority (HCA)

Disclosure notice

Nondiscrimination