Dental Services

Dental Services

Dental Services

Acentra Health serves as the Prior Authorization (PA) administrator for Arkansas Medicaid dental services. Our dental review team evaluates authorization requests to ensure services meet Arkansas Medicaid policy and clinical criteria. Providers may submit prior authorization requests for review before services are rendered, retrospective requests for services already provided (in limited circumstances), or reconsideration requests for services that were previously denied.

Acentra Health Reviews Two Types of Authorization Requests

• Prior Authorization Requests
• Retrospective Review Requests

Prior Authorization Requests

Prior Authorization requests are submitted before treatment is rendered and must receive approval, when required, prior to the date of service.

Providers should refer to the current Procedure Code Table (PCT) for a complete listing of codes that require prior authorization and any associated submission requirements.

It is important to note that only procedure codes submitted on the authorization request clinical lines will be reviewed. Providers are responsible for entering all requested procedure codes and associated tooth numbers or quads, on the authorization request. Services referenced in clinical notes, narratives, attachments, or provider messages, but not included on the clinical lines, will not be reviewed or considered for authorization.

To avoid processing delays, please ensure that all requested services are accurately entered on the authorization request at the time of submission.

Retrospective Review Requests

Retrospective review requests are submitted after treatment has been rendered. These requests are only considered under the following circumstances:

• Unplanned child sedation
• Emergency services
• Retroactive Medicaid eligibility

Requests submitted retrospectively must meet one of the criteria listed above to be eligible for review.

To support the review process, providers are encouraged to submit the following documentation with all retrospective review requests:

1. Progress notes from the date of service.
2. A detailed narrative substantiating the reason for the retrospective submission.
3. A dated treatment plan.
4. Dated radiographs.

Providing complete documentation at the time of submission may help facilitate a timely and thorough review.

Reconsideration Reviews

Acentra also reviews reconsideration requests. A reconsideration is a re-review of previously denied procedure codes when additional information or clarification is available.

To be eligible for reconsideration, providers must submit their request within 65 calendar days of the date on the original determination letter.

Providers should include any additional supporting documentation that was not previously reviewed, and that may assist in the reconsideration process.