CSHCN 2009 > Dental > Benefits and Limitations

14.2 Benefits and Limitations

14.2.1 Prior Authorization Requirements

Prior authorization is required for all orthodontia services and selected dental services. Refer to individual sections throughout the chapter for specific authorization requirements. All requests must be submitted using the CSHCN Services Program Prior Authorization Request for Dental or Orthodontia Services form. The TMHP-CSHCN Services Program may require the submission of X-rays, models, etc., for specific prior authorized services. All prior authorization requests must include specific rationale for the requested service, including documentation of medical necessity and appropriateness of the recommended treatment. Additional documentation, including current periapical radiographs, must be maintained in the client's medical or dental record and submitted to the CSHCN Services Program on request.

Important: Refer to each individual section under Benefits and Limitations for specific information about prior authorization requirements.

Refer to: Section 4.3, "Prior Authorizations" for detailed information about prior authorization requirements.

Appendix B, "CSHCN Services Program Prior Authorization Request for Dental or Orthodontia Services" for an example of this form.

Note: Fax transmittal confirmations are not accepted as proof of timely prior authorization submission.

Tip: Photocopy this form and retain the original for future use.