Newsletter Vol. 29, No.16

By November 1, 2019: Billing team and dental providers must implement the following changes: (1) Obtain and use the HLD (NJ-Mod3) Assessment Tool for all comprehensive orthodontic cases to document medical necessity; (2) Create and implement an Informed Consent Form that addresses age limits, treatment length, consequences of appliance breakage, and patient/guardian responsibilities; (3) Update billing system to remove prior authorization requirement for D9310 (Orthodontic Consultation) and D8660 (Pre-orthodontic Treatment Visit), but ensure these codes are linked to the provider, not the patient; (4) Implement prior authorization workflow for limited (D8660), interceptive, and comprehensive (D8670) orthodontic treatment cases, ensuring submissions include HLD (NJ-Mod3) tool, clinical narratives, diagnostic materials, and attestation from referring dentist that preventive care is complete; (5) Set billing system rules to cap D8670 periodic treatment visits at 24 units maximum per comprehensive case (36-month duration); (6) Ensure all approved cases are started within 6 months of approval or authorization lapses; (7) Update claim processing to require pre- and post-treatment photographs upon case completion. Failure to obtain prior authorization for treatment services will result in claim denials. Front desk and clinical staff must confirm patient eligibility prior to each visit.