Tuesday, December 21, 2021
The purpose of this transmittal is to notify Medicaid fee-for-service (FFS) dental providers of the forms required for prior authorization (PA) for comprehensive orthodontic treatment for DC Medicaid beneficiaries effective January 3, 2022.
File SizeFile SizeFile Size
Orthodontic Continuation of Care Form DHCF.pdf - 27.0 KB (pdf) DC HLD Scoresheet DHCF.pdf - 202.9 KB (pdf)
Attachment(s):
Orthodontic Continuation of Care Form DHCF.pdf - 27.0 KB (pdf) DC HLD Scoresheet DHCF.pdf - 202.9 KB (pdf)