Glitch in Medicaid Surgical Extraction Codes; Changes Proposed to Program

by Billy Tarpley on June 6, 2013

Recently many Arkansas Medicaid dental providers experienced a glitch in submitting Medicaid claims for surgical extractions. The glitch occurred when the system implemented a change in the prior authorization process on June 1 rather than the pending August 1 planned implementation date. If you have experienced a denied claim, please contact Ward Hannah, DHS Business Operations Manager, at 501-320-6201 or Chawnte Booker, program coordinator, at 501-320-6211.

Meantime, be advised that plans are underway to reinstate prior authorization process for a number of dental procedures, including surgical extractions, for Medicaid pediatric patients effective August 1, 2013. The proposed changes are open for public comment. 

The proposed changes to take effect August 1 presently include the following:

  • Limitation to 5 periapical xrays per fiscal year
  • Implementation of “retrospective review” process for endo procedures
  • Reinstatement of prior authorization for surgical extractions
  • Benefit limit to 2 evaluations per fiscal year for pedo
  • New ortho policy to approve only the most severe cases; possible increase in point system

If you would like to post a comment to the proposed changes, visit the link below:


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