Dental
Phoenix Health Plan members under age 21 are covered for comprehensive dental services. The use of preventive dental services is strongly encouraged. To support this, Phoenix Health Plan contracts directly with dental providers and allows members to select a dentist from a published dental directory. No PCP referral or prior authorization is required for a member to see a contracted general dentist.
Dental services for adults are limited to emergency dental services, medically necessary dentures and pre-transplant dental services. Specific dental services covered under these limitations can be determined by the member's dentist. No prior authorization is needed for emergency services.
Requesting a Dental Prior Authorization
Phoenix Health Plan requires prior authorization for selected services. These services are outlined and summarized in the Dental Matrix. To see click here.
For the Prior Authorization Form click here.
Dental Office Responsibility in Prior Authorization
The following is an outline of the role and responsibilities of the dental office in the Prior Authorization process:
- Verify member eligibility before each appointment, particularly if multiple visits are authorized.
- Determine if the service(s) requires prior authorization.
- Submit a pre-treatment estimate by mail on an ADA form along with the Dental Prior Authorization Request Form to our Dental Prior Authorization unit. Include necessary supporting documentation of diagnostic quality (x-rays, narrative, charting).
- For a referral to a specialist, submit the Dental Prior Authorization Request Form to the Dental Prior Authorization Unit. State the reason for the need to refer to a specialist on the form.
- Refer only to Phoenix Health Plan contracted dental specialists. If you need a Specialist List, please contact your Provider Representative or refer to the provider directory on this web site.
If a treatment plan changes, or if during the course of treatment an immediate procedure which is a covered service is required, do not interrupt a patient's care in order to obtain authorization. After the treatment, submit any changes to the original authorization that are needed, along with relevant documentation, and Phoenix Health Plan will respond to the change request.