Dental Prior Authorization

Request for prior authorization should be filed on the ADA 2006 claim form accompanied by sufficient documention, i.e., study models (where indicated), radiographs to substantiate need and documentation that the requested services would be within the scope of the OHCA Dental Program.

Minimum required records to be submitted with each ADA 2006 claim form are right and left mounted bitewing x-rays and periapical films of tooth/teeth involved or the edentulous areas if not visible in the bitewings. Each film/print must be identified as to left and right. The film/print must clearly identify the requested service. Tooth or teeth numbers with surfaces involved should be listed, and x-rays mounted and identified with client name, OKDHS case number, provider name and number. This should be stapled to the ADA 2006 claim form. If you are requesting periodontal services please also send periodontal charting.

Please note that prior authorization will take approximately 4-6 weeks to process from the date mailed until you receive your notice via Provider Secure Site indicating services were denied or approved. A letter is also sent to the patient's family.