Apple Health (Medicaid) Provider Alert

Attention Orthodontic providers:

The Health Care Authority (HCA) revised the Orthodontic Information form
HCA 13-666 (3/22). Providers must download the new form from the HCA Forms and Publications webpage. The revised form will be available on the Forms and Publications webpage on February 1, 2022. Orthodontic authorization requests must be submitted using the most current form on and after March 1, 2022, or they will be rejected.