Current Backlog! Due to the dental prior authorization request backlog, a request received for a service that becomes “non-covered” effective July 1, 2010, will be reviewed as if it is a covered service as follows: if the date on the request is prior to July 1, 2010, the request will be reviewed under the policy in effect at the time of the receipt of the request. This applies only to a service that had been covered before July 1, 2010, but becomes non-covered on that date. We apologize for the backlog and we believe this is the most fair measure the department can put into place under these circumstances.
Changes to dental rates and benefits effective 7/1/10. Effective for dates of services on or after 7/1/10, the department is making changes to rates for some dental services and some services for adults are no longer covered or are now reduced to a lifetime limit. See Dental fee schedule (coming soon) and memo (updated 6/25).
ProviderOne is now live!
CORRECTION - Billing Instructions
The Washington State Medicaid wishes to announce an error was made in its recently published Dental Fee Schedule and Billing Instructions titled: "Dental Program for Clients Age 21 and Older". These publications state that prior authorization is now required for:
CDT code: D4341 periodontal scaling and root planing - four or more teeth per quadrant
CDT code: D4342 periodontal scaling and root planing - one to three teeth per quadrant
Please disregard this requirement. We apologize for the inconvenience this may have caused you or our clients.
Current Dental Terminology (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright © 2008 American Dental Association. All rights reserved. Applicable FARS/DFARS Apply.
Dental Program for Clients Through Age 200
Dental Program for Clients Age 21 and Older
NEW As of October 1, 2009, submission of the Agreement of Acceptance form is not required for payment. This form must be retained in the client's record and available upon request by DSHS.
NEW Fee Schedule effective July 1, 2009
NEW Dental Provider Memo, effective July 1, 2009
CMS Response to Frequently Asked Questions
(billing clients, accepting Medicaid clients)
Making Medicaid Easy (Tutorial)
Medicaid client information: Questions about Medicaid's dental coverage are best directed to your own family dentist. However, when that is not practical, clients with questions, complaints or problems are welcome to call the Medical Assistance Customer Service Center at 1-800-562-3022. Provider questions can be directed to the same number.
New Dental Newsletter February 5, 2009
On July 1, 2008, HRSA will require the most current ADA claim form (2006) for billing. Claims submitted on non-ADA claim forms will be returned to provider.
Electronic Billing HRSA encourages providers to bill electronically for the most efficient distribution of payment (see billing instructions). http://www.acs-gcro.com Click Medicaid then Washington State.
The purpose of the Dental Program is to reimburse for quality dental and dental-related services to eligible clients.
Use the links at the top for information specific to our dental providers. Use the links to the left for general medical assistance provider billing information.
We want to hear from you! Let us know what you would like to see on our dental Web site. Email us at contact us with your suggestions and thoughts.
Our staff provides on-site or in-house provider training on billing and claims issues. Use this link to contact us.
For comments or questions, email contact us
Page modified: September 2010