MedicaidDocumentationMedium impact
Departmental Review in Orthodontic Appeals
Maryland Medicaid·MD · Dentistry·Managed Care Organizations
Effective date
Jan 2, 2004
We identified it
Jun 20, 2026
Summary
Maryland Medicaid MCOs must now submit a complete package of 7 specific dental components (HLLD scoresheets, photographs, study models, radiographs, etc.) within 15 working days when orthodontic appeals are requested through the HealthChoice Enrollee Action Line. Failure to submit complete records on time will result in the Department ordering the MCO to provide orthodontic coverage.
Action Required
Effective January 2, 2004: When handling orthodontic appeals for Maryland Medicaid HealthChoice enrollees under 21, billing team must ensure MCO submits complete package of 7 dental components (HLLD scoresheets from orthodontist and MCO, extra/intra oral photos, study models with wax bite, cephalometric head film with analysis, panoramic/periapical radiographs, clinical exam summary with diagnosis/treatment plan) to Complaint Resolution Unit within 15 working days of appeal request. Incomplete or late submissions will result in Department ordering orthodontic coverage approval.