CSHCN 2009 > Dental > Benefits and Limitations

14.2.5.1 Prior Authorization Requirements

Prior authorization requirements for specific procedures are contained within each section below, as appropriate. Prior authorization is valid up to 90 days. To obtain prior authorization, the following must be submitted:

•The CSHCN Services Program Prior Authorization Request for Dental or Orthodontia Services form

•Provider documentation supporting the medical necessity and appropriateness of the recommended treatment

Additional documentation, including current periapical radiographs, must be maintained in the client's medical record and submitted to the CSHCN Services Program on request.

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.