Orthodontists 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.

In order to efficiently process your requests for minor and comprehensive orthodontia (all D8000 series), please be sure to place the following IN ONE BOX:

The following information/records are required to process all request:

  • ADA 2006 claim form and HLD-1 form, if it is for comprehensive ortho;
  • Study Models or 3-D model images;
  • Panoramic x-ray;
  • Cephalometric x-ray with tracing. 

Of course, if you are sending several requests at once, they may be sent in one large box, but please DO NOT SEPARATELY MAIL the paperwork from the study models and panoramic x-rays. Please note that study models and panoramic x-rays are required for evaluation of minor orthodontia (retainers, etc.).

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