On March 9, 2016, Pierce County Oral Health Coalition members and others convened to gain insight and updates on Washington State’s Apple Health (Medicaid) dental coverage for children and adults. In her presentation, Dianne Baum, Dental Program Administrator for Washington Apple Health shared: status and scope of dental benefits provided to our state’s residents who qualify for Apple Health benefits, state-wide Apple Health dental provider statistics, and important information on state provider audit programs and potential audit criteria and triggers.

Providers are responsible for checking the HCA website for updates. Washington’s Apple Health Dental Billing Guides are updated quarterly: January, April, July and October. There is a separate guide for the Access to Baby and Child Dentistry (“ABCD”) program. Ms. Baum suggested signing up for “go-delivery” e-mails and visiting the Dental webpage.

An engaging question and answer session followed the presentation, focused primarily on preauthorization of dental services and other claims handling issues. Ms. Baum’s presentation included helpful links and contact information for providers. Apple Health clients will also find valuable information about their benefits on HCA’s “For Clients” page, including a current summary of adult dental benefits.

“This was incredibly helpful and specific information for dental billers, and nice to have additional Health Care Authority Apple Health resource information,” remarked one participant.

Presentation Handouts:

• WA Dental Program Presentation 2016 (see last page for helpful links and email info)
• Utilization of Dental Services_Health Care Authority_FY2014_2015
• Provider One Spenddown Step-by-Step_2015.06