Use the steps below when authorization is required.
For procedures where “Authorization Required” fields indicate “yes”.
Please review the information below on when to submit documentation to DentaQuest. The information refers to the "Documentation Required” field in the Benefits Covered section (Exhibits). In this section, documentation may be requested to be sent prior to beginning treatment or “with claim” after completion of treatment.
When essential information is missing from a prior authorization, DentaQuest will notify provider and member no later than three business days after the PA was received, with explanation of what is missing/incorrect/illegible. When possible, a call will be made to the provider to obtain missing information.
If the documentation is not received by DentaQuest by the end of the third business day after prior authorization receipt date, a Dental Consultant will review the prior authorization with the information received in the initial request.
Within three business days after the prior authorization has been sent for Dental Consultant review, but no later than the tenth business day after the receipt date, a final notice will be sent to the provider and member of the Dental Consultant’s decision.
Final decisions will be made within three business days after the missing information was received by DentaQuest.
Holidays may result in the process exceeding the fourteen day time limit and DentaQuest will adjust accordingly.
Prior Authorization Annual Review Report