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Reminder - Revised Orthodontic Information form (HCA 13-666), effective 3/1/2022
Washington Apple Health·WA · Orthopedics·Provider Alert
Effective date
Mar 1, 2022
We identified it
Jun 20, 2026
Summary
Washington State Health Care Authority has revised the Orthodontic Information form HCA 13-666 and requires all orthodontic authorization requests to be submitted on the new form starting March 1, 2022, or they will be rejected.
Action Required
By March 1, 2022: Orthodontic providers must download the revised Orthodontic Information form HCA 13-666 (3/22) from the HCA Forms and Publications webpage and use only this new form for all orthodontic authorization requests. Stop using the old form immediately after March 1st. Failure to use the current form will result in authorization request rejections.