Get RIte Smiles Medicaid Orthodontic prior authorization approvals faster

Q4 Word of Mouth newsletter 2022

Correctly submitting prior authorization requests when treating Rhode Island RIte Smiles Medicaid Orthodontic members can help speed up the approval process. This enables you to minimize patients’ wait time and improve their experience by meeting the required criteria.

Required materials with your submission

  • A completed American Dental Association® claim form
  • A completed Severe Malocclusion Treatment Request Form
  • Handicapping labio-lingual deviation (HLD) index diagnostic score sheet
  • Cephalometric film, lips together, including tracing
  • Photographs
  • A digital panoramic image 

Be sure to clearly label all documents, radiographs and photographs with the patient’s name, date and the name of the dental professional requesting the treatment.

You may support your requests for treating handicapping malocclusion by submitting:

  • A minimum score of 26 or an indication of an automatic qualifier on the HLD index
  • Clinical records that validate the HLD index score

A board-qualified orthodontic consultant will review the HLD index. RIte Smiles benefits for code D8670 is limited to 23 visits in the member’s lifetime.

There is a library of resources available to answer questions and help you learn more about submission requirements for preauthorization requests. Check them out today.

Dr. Alan Chusid
Associate Director, Clinical Consult, UnitedHealthcare Dental