1. DENTAL PRIOR AUTHORIZATION
PROVIDER PORTAL AND POLICY

2. LOGIN

3. Create dental prior authorization

4. Create dental prior authorization
Arial is font for body copy

5. Create dental prior authorizationB
BBB

6. Diagnosis information is required for dental prior authorization

7. Diagnosis information resources
Providers – Dental – Dental ICD-10 Information
ICD-10
Google search

8. Create dental prior authorization

9. Create dental prior authorization

10. Add attachments

11. By mail attachments

12. Add attachments continued
Attachments are listed

13. Prior authorization continued
Add service after all attachments are added

14. Prior authorization continued
Continue adding service details then submit

15. Confirm prior authorizationB

16. Authorization receipt

17. Authorization receipt attachment coversheet
“BY MAIL” attachments require the HCA-13D coversheet

18. Dental PA attachment cover sheetB

19. View authorization status

20. Enter search criteria
DO NOT USE B

21. Search results Click on prior authorization number to open B99999999 B

22. View authorization response
Click on Print Preview or blue hyperlinks to obtain tooth numbers and remarks

23. View authorization response, cont.

24. Advanced search B
Advanced search allows you to see all of a members dental prior authorizations regardless of requesting provider
Mickey Mouse

25. View authorization response
Click Print Preview or blue hyperlink to view tooth number

26. View authorization response, cont.

27. Attach pending documents

28. Attach pending documents, cont.B
Click on + sign to open an attachment box

29. Attach pending documents, cont.
Transmission Method box opens up to allow you to attach requested documents
Original attachments are shown

30. Attach pending documents, cont.

31. Search notices

32. Search notices, cont.

33. Search notices, cont.
Click on Prior Authorization number to view prior authorization
Click on date to change status from unread to read

34. Verify eligibility

35. Verify eligibility, cont.

36. Coverage details B

37. Treatment history

38. Treatment history, cont.B
“WARNING” lifetime is for once in a lifetime services NOT lifetime history
Example: Extractions, Root canals

39. Treatment history results
Click on any procedure code to obtain more information B

40. Treatment history, cont.B

41. required documents for PRIOR AUTHORIZATIONS
Minimum records to be submitted with every dental request include:
HCA-13D cover sheet for “BY MAIL” dental prior authorizations
Periapical films of tooth/teeth involved

42. required documents for PRIOR AUTHORIZATIONS, cont.
Right and left bitewing x-rays
Comprehensive treatment plan
Six-point periodontal charting, if requesting periodontal services

43. Hca-13D dental Prior authorization cover sheet

44. Orthodontic Prior authorization required documents
Minimum records to be submitted with comprehensive orthodontic request:
Completed and scored handicapping labio- lingual deviations index (HLD-1) with diagnosis of angle’s classification
Detailed description of any oral maxillofacial anomaly
Estimated length of treatment

45. Orthodontic Prior Authorization required documents, Cont.
Intraoral photographs showing teeth in centric occlusion and/or photographs of trimmed anatomically occluded diagnostic casts. A lingual view of casts may be included to verify impinging overbites
Cephalometric x-rays with tracing, and panoramic film

46. Orthodontic Prior Authorization required documents, cont.
If diagnosed as a surgical case, submit an oral surgeon’s written opinion that orthognathic surgery is indicated and the surgeon is willing to provide the service.
Referral from general dentist (DEN-2)
Caries risk assessment

47. Sealant frequency – once per three years
Policy updates
Sealant frequency – once per three years
Utilization parameters –one permanent restorative service provided per tooth per 24 months
Comprehensive orthodontic treatment – member must be caries free for 12 months to obtain a referral to an orthodontist

48. Common general dental Line item errors
Each requested service must have its own line item.
For example:
D4341 UR
D4341 UL
D4341 LR
D4341 LL
Correct
Incorrect:
D units

49. Common orthodontic Prior Authorization line item errors
Each year of requested orthodontic treatment must have its own line item.
For example:
D8080
Correct
Incorrect:
D units

50. Dental provider contracts expire on 9/30/2017
Did you know?
Dental provider contracts expire on 9/30/2017
Renewal process begins on 7/17/2017
Group contracts expire on 11/30/2017
Renewal process begins on 9/6/2017
Web alerts now has an option for provider training.

51. Contact us
Dental Prior Authorization Provider Services

52. Dental Prior Authorization Team
Dr. Leon Bragg – Chief Dental Officer
Dr. Courtney Barrett – Dental Consultant
Dr. Richard Gilman – Orthodontic Consultant
Tracy Matthews – Dental Program Coordinator
Dana Drew – Dental Analyst
Sara Gillum – Dental Analyst
Wendy Payne – Dental Analyst
Tiira Carreon – Administrative Assistant

53. Questions?