Update: Prior Authorization Requirements for Dental Procedures under General Anesthesia
Date: 05/31/23
Heritage Health (Medicaid):
Update: All dental procedures performed in the hospital or ASC do not require prior authorization by Nebraska Total Care when MCNA has prior authorized the services to be performed under general anesthesia. Without the MCNA prior authorization, the procedure will be denied as not medically necessary.
Effective May 1st, 2019, MCNA, the Dental Benefit Manager for Nebraska Medicaid, is revising its requirement for dental therapy performed under general anesthesia. For clients who are under 19 years of age, dental therapy performed under general anesthesia must be prior authorized with MCNA by the dentist performing the dental procedure. If the procedure is to be performed at a hospital or ambulatory surgery center (ASC), the dentist is responsible for providing documentation of MCNA’s approval to the hospital facility, ASC and/or anesthesiology provider. This process does not apply to oral surgeons.
All dental procedures performed in the hospital or ASC will continue to require prior authorization by Nebraska Total Care. For members under age 19, the facility/anesthesiologist must submit verification that MCNA has prior authorized the services to be performed under general anesthesia. Without the MCNA prior authorization, the procedure will be denied as not medically necessary. You may download the MCNA prior authorization form.
Please share this information with the utilization management staff/department at your facility that is responsible for the authorization process with Nebraska Total Care so that they are aware of this new requirement.
If you have any questions, please contact Provider Relations.