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 specialist or general dentist.
Adult members 21 years of age and older receive no dental services including emergency dental services, unless the procedure can be performed by a doctor as well as a dentist. Emergency dental services are for immediate treatment of pain, infection, swelling or dental injuries.
Website Link to AHCCCS Benefit Changes
DENTAL BLAST FAX
Requesting a Dental Prior AuthorizationPhoenix Health Plan requires prior authorization for selected services.
View Recent Changes to the Dental Matrix
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 to our Dental Prior Authorization unit. Include necessary supporting documentation of diagnostic quality (x-rays, narrative, charting).
- 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 patient's pain is impacting their everyday schedule, treat the patient for pain and send in a retro claims review along with the ADA form, detailed chart notes, and pre & post-op x-rays.
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.