MedicaidCoverageHigh impact
Dental Office Reference Manual (DORM)
Illinois Medicaid - HFS·IL · Dentistry·Provider Notice
Effective date
Jul 1, 2012
We identified it
Jun 20, 2026
Summary
Illinois Medicaid dental program updated key policies including EPSDT service definitions for children, new prior authorization requirements for medically necessary dental services beyond standard benefits, adult dental coverage limited to emergencies only, and reduced claim filing deadline to 180 days from date of service.
Action Required
Immediately: Update billing procedures to submit prior authorization for EPSDT dental services beyond standard benefits using ADA Claim Form with EPSDT/Title XIX checked in Box #1, procedure codes in Box #29, and service descriptions in Box #30. Limit adult dental billing to emergency extractions only (pain, infection, swelling, bleeding, trauma). Update claim submission deadline to 180 calendar days from service date for all claims dated July 1, 2012 and after. Verify pediatric eligibility before and during orthodontic treatment to prevent age-out issues.