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HCA: Orthodontic Information Form (HCA 13-666) Reminder

Feb 4, 2021
The Health Care Authority (HCA) recently sent the following alert to dental Medicaid providers.

Attention Orthodontic providers:

Reminder to billers of orthodontic services!

When completing the Health Care Authority’s (HCA’s) Orthodontic Information (HCA 13-666) form, you must complete Part III, the Washington Modified Handicapping Labiolingual Deviation (HLD) Index Score, for all prior authorization requests. This is not a new requirement. Instructions for completing the Orthodontic Information form are located in HCA’s Orthodontic Services Billing Guide.

Effective immediately, HCA will reject forms submitted without the HLD score.