Dental Authorization
Authorization is based on medical necessity determined by Medical Assistance and must take place before the service is provided. We may require second opinions and/or consultations before authorizing any procedure.
Something you need to know:
A dental authorization is required for specific
procedures. Approval is valid only if the client is eligible for covered
services on the date of service.
How do you request authorization? We require a dental provider who is requesting authorization to submit a completed ADA Dental Claim Form and sufficient, objective, and clinical information to establish medical necessity. If approved, the ADA Dental Claim Form will be returned to you with an authorization number.
Prior Authorization requests will be pended (returned) for the following
reasons:
Removable prosthetics:
Lack of diagnostic radiographs
Failure to list missing teeth or teeth to be extracted
Incomplete prior authorization form
Crowns for endodontically treated teeth must have final obturation radiograph
Inquires about the status of your payment can be sent to provider relations.
Please refer to the appropriate program regulations or billing instructions for the dental-related services requiring authorization.
WAC Program Regulations:
388-535-1220 Obtaining prior authorization for dental-related services -- Children
388-535-1280 Obtaining prior authorization for dental-related services -- Adults
How do I submit a request? An electronic (faxed) authorization request for services that do not require radiographic or photographic submission can be faxed to (360) 725-2123.
An authorization request that requires radiographs or photographs must be mailed to:
Dental Services and Consultation Section
PO Box 45506
Olympia, WA 98504-5506
Note: Radiographs should be duplicates as they will not be returned. Originals are to be maintained in the clients chart.
New radiographic data warehouse services available through National Electronic Attachment Inc. (NEA) for information call 1-800-782-5150, ext. 2. See NEA Provider FAX.
Please use the "comment section" of the authorization request to explain justifications for treatment when appropriate.
Please allow 15 working days for your request to be processed. The Dental Services and Consultation Section (DSCS) will contact you if additional information is required.
Questions regarding your prior authorization request can be emailed to provider relations. Please include the client PIC, your provider number, procedure code, and your issue so we are able to research and expedite your request. Or you can call 1-800-562-3022.
Use this link to access the American Dental Association's Product Catalog. On this site you will be able to purchase dental claim form J515. After selection the product catalog link, you must log in using your ADA 9 digit number to access forms.
For comments or questions, email contact us