MedicaidPrior AuthMedium impact
Dental surgeries - payment of facility fees requiring prior authorization
Washington Apple Health·WA · Dentistry, Oral & Maxillofacial Surgery·Prior Authorization
Effective date
Jan 1, 2020
We identified it
Jun 20, 2026
Summary
For Apple Health (Medicaid) dental surgery facility fees, billing teams must now provide HCA's prior authorization approval letter and include the PA/EPA number when billing managed care organizations to avoid claim denials. This clarifies the billing process for outpatient, inpatient, and ASC facility fees for dental surgeries.
Action Required
Immediately: When billing Apple Health MCOs for dental surgery facility fees requiring prior authorization, billing team must include a copy of HCA's approval letter with the claim and enter the PA or EPA number on the billing. Update billing workflows to ensure these documents are attached to avoid claim denials.