Clarification of Authorization and Claims Submission Requirements for Dental Surgery Services Performed in Ambulatory Surgery Centers and Outpatient Hospital Settings

By August 1, 2024: Billing team and clinical staff must implement the following: (1) Ensure all providers complete the Facility Referral Form (available in Provider Manual and web portal) BEFORE scheduling dental surgery in ASC or Outpatient Hospital settings; (2) Require providers to identify the health complication or conduct disorder on the form with appropriate narratives (narrative required for children 6+ years on option #1; narratives required for all ages on options #2-6); (3) Require treatment plan and supporting documentation (X-rays, photographs, etc.) submission with the Facility Referral Form; (4) Obtain prior authorization for D9999 with $0 billed amount before submitting claims; (5) Update billing system to enforce Place of Service code 24 (ASC) or 22 (Outpatient Hospital) on all such claims; (6) Train billing staff to itemize and submit all associated dental services on a single claim with the approved D9999. Update encounter forms and referral workflows to include these requirements. Verify authorization approval before claim submission. Claims submitted without required documentation, appropriate POS code, and preauthorized D9999 will be denied.