Attention Orthodontic providers:

The Health Care Authority (HCA) sent a provider alert on January 27, 2022, regarding the revised Orthodontic Information form HCA 13-666.

As a reminder, HCA revised the Orthodontic Information form 13-666 (3/22). Providers must download the new form from the HCA Forms and Publications webpage. The revised form became available on the webpage on February 1, 2022. Requests for orthodontic authorization must be submitted on the most current form on and after March 1, 2022, or they will be rejected.