TMPPM 2008 > Texas Medicaid Services > Dental > Change of Provider

19.9.1 Interrupted or Incomplete Treatment Plans

Authorizations for orthodontic or extensive restorative treatment plans that have been prior authorized for a provider are not transferable to another provider. If a client's treatment plan is interrupted and the services are not completed, the new provider must request prior authorization to complete the interrupted, incomplete, and prior authorized treatment plan initiated by the original provider.

To complete the treatment plan, the client must be eligible for Medicaid with a current client Medicaid Identification Form (Form H3087) or Medicaid Eligibility Verification Form (Form H1027).

If the client does not return for the completion of services and there is documented failure to keep appointments by the client, the dental provider who initiated the services may submit a claim for reimbursement. The claim must be received by TMHP within the 95-day filing deadline from the last date of service.

Refer to: "Transfer of Orthodontic Services" for more information.