Prior Authorization

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.

Authorization Process

Important Documents:

Authorization Catalog

Prior Authorization Annual Review Report

"Review Required" Field	"Documentation Required" Field	Treatment Condition	When to Submit Documentation
Yes	Details on what specific documentation is required	Non-emergency (routine)	Send documentation prior to treatment
Yes	Details on what specific documentation is required	Emergency	Send documentation with claim after treatment

"Review Required" Field	"Documentation Required" Field	Treatment Condition	When to Submit Documentation
Yes	Documentation Requested with Claim	Non-emergency (routine) or emergency	Send documentation with claim after treatment

Authorization Process

When documentation is requested: expand accordion

When documentation is requested "with claim": expand accordion

How long does it take to determine a submitted prior authorization? expand accordion

How long is an authorization valid? expand accordion

What documentation will the member and provider receive after an authorization is determined? expand accordion

Notification Process for Incomplete Prior Authorization Requests: expand accordion

Have Questions or Need Assistance? expand accordion

Important Documents:

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