Dentaquestdental Prior Authorization Lookup
Latest Dentaquestdental prior authorization updates9
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Colorado Child Health Plan Plus Orthodontics — Comprehensive Orthodontic Treatment (Child Members 18 and Younger)Defines coverage, prior authorization, documentation, billing and provider requirements for comprehensive orthodontic treatment for Colorado Child Health Plan Plus members aged 18 and younger.All dentaquestdental updates
- Prior AuthClinical/Medical PolicyEff. 2020-01-01Utilization Management Prior Authorization and Review ProceduresGoverns DentaQuest Dental's processes for prior authorization, prepayment and retrospective review of dental services requiring medical necessity review; applies to providers and members across all lines of business (Kentucky referenced in header).All dentaquestdental updates
- Prior AuthAdministrative/Operational PolicyEff. 2019-01-01Verbal Notification of Prior Authorization DeterminationsDefines DentaQuest's process for verbally notifying members and providers of prior authorization determinations, applying to government program members and associated providers across all states.All dentaquestdental updates
- Prior AuthClinical/Medical PolicyEff. 2018-01-01Review Process and Criteria for Dental Services Subject to Prior Authorization (Pre-service) or Retrospective ReviewDefines the Health Plan's process, criteria, and list of dental services that require prior authorization (pre-service) or retrospective review for Community HealthChoices participants; applies to providers submitting authorization requests to DentaQuest Dental for KFCHC and ACPCHC line(s) of business.All dentaquestdental updates
- Prior AuthClinical/Medical PolicyEff. 2012-03-01Orthodontia Review Policy and Procedure — Texas Children's Medicaid/CHIPGoverns determination, prior authorization, documentation, provider qualifications, and coverage levels for medically necessary orthodontic services for Texas Medicaid and CHIP pediatric members (including certain pre/post surgical cases). Applies to providers seeking reimbursement through DentaQuest Dental for these programs.All dentaquestdental updates
- Prior AuthClinical/Medical PolicyEff. 2011-09-17Review Process and Criteria for Dental Services Subject to Prior Authorization (Pre-service) or Retrospective ReviewDefines the Health Plan's process for prior authorization and retrospective review of specified dental services, who performs reviews, documentation and PHI handling, and lists services/codes requiring authorization. Applies to Keystone First and AmeriHealth Caritas Pennsylvania members and participating providers.All dentaquestdental updates
- Prior AuthReimbursement/Payment PolicyDentaQuest Dental procedure code coverage and documentation/payment review requirementsThis document lists dental procedure codes with age/tooth limits, prior review requirements, and required documentation (narrative of medical necessity, pre/post-op x‑rays, models/images) governing prior authorization and payment review for providers submitting these codes to DentaQuest Dental.All dentaquestdental updates
- Prior AuthAdministrative/Operational PolicyGeneral Anesthesia (D9500) prior authorization and claims submission guidanceGoverns use of procedure code D9500 for preauthorization submissions and claims for DentaQuest members six years of age and younger; describes required documentation and billing rules and warns that D9500 must not be billed on claims for payment.All dentaquestdental updates
- Prior AuthClinical/Medical PolicyHealth First Colorado Orthodontics (Criteria for Orthodontics — Children 20 and Younger)Defines medical necessity, prior authorization, billing, and coverage rules for orthodontic treatment for Health First Colorado members age 20 and younger, including documentation requirements, covered/ noncovered codes, continuation/transfer of care, and payment rules.All dentaquestdental updates
Tool Description
Search Dentaquestdentalprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
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Prior Authorization by Payer
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Prior auth requirements change all the time. Keep up with every payer policy update in the live policy feed, or browse payers with prior authorization policies.
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