MedicaidAdministrativeMedium impact
Dental-related services - client limit inquiries
Washington Apple Health·WA · Dentistry·Provider Alert
Effective date
Nov 23, 2022
We identified it
Jun 20, 2026
Summary
Washington State Health Care Authority is experiencing delays in processing dental service limit requests beyond the usual 48 hours due to increased volume. Providers must follow specific steps before submitting limit inquiries, including checking eligibility, confirming benefit coverage, reviewing billing guides, and avoiding duplicate or template requests.
Action Required
Immediately: Before submitting any dental service limit inquiries, billing team must: 1) Check client eligibility and confirm Apple Health/Medicaid enrollment, 2) Confirm the client's benefit package covers the requested service, 3) Review appropriate dental billing guides to verify service limitations and age coverage requirements, 4) Submit only one request per service (no duplicates), 5) Request only services that will actually be performed (no template submissions). Access billing guides at the Provider billing guides and fee schedules webpage.