How to Submit a Dental Predetermination

Dental predeterminations can be submitted in advance to verify a member’s benefits before services are started. This helps in coordinating financial arrangements for reduced or uncovered services.

You can submit a dental predetermination request the same way you submit a claim through:

• Electronic Data Interchange(EDI)
• Availity > Claims & Payments > Claims & Encounters
• Or by mail to:
  Dental Review
  PO Box 91059
  Seattle, WA 98111-9159

Use the code check tool in Availity to see which procedure codes recommend pre-determination.

For dental prior authorization for the following services, you can fax a dental prior authorization form to 425-918-5956:

• Cosmetic and reconstruction services
• General anesthesia and facility services related to dental treatment
• Orthodontic services for treatment of congenital craniofacial anomalies
• Orthognathic surgery
• Temporomandibular joint disorder (TMJ)