MedicaidAdministrativeMedium impact
MAB2021041501
Pennsylvania Medicaid (DHS)·PA · Dentistry·Provider Bulletin
Effective date
Mar 1, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania's Medical Assistance Program has streamlined the dental Benefit Limit Exception (BLE) process for adults 21+ by allowing automatic approval for patients with specific conditions (diabetes, coronary artery disease, cancer of face/neck/throat, intellectual disability, current pregnancy) if these conditions appear in their claims history. This eliminates the need for supporting medical documentation in most cases.
Action Required
Immediately: Dental billing staff should update BLE request procedures to identify patients with diabetes, coronary artery disease, cancer of face/neck/throat, intellectual disability, or current pregnancy in claims history before submitting requests. When submitting BLE requests for these conditions, note the condition in the request but do not automatically gather medical documentation unless specifically requested by the Department within 15 days.