Prior Approval Items- Dental

The Prior Approval Items tab for Dental requests allows you to input service lines identifying the services that are being requested for the patient. The main body of the tab is an arrangement of fields with each row representing a requested service line. The following fields are displayed:

• Line: The line number of the request. You may not change this field. Note that the request line numbers and the subsequent claim line numbers do not have to match.

• Service Date: The estimated or proposed date that the requested service is to be performed. Must be greater than or equal to the current date.

• Proc & Modifier: The HCPCS procedure code and the procedure code modifier.

• Arch/Quad: The Oral Cavity code populated from the adjacent pop-up. You may enter either an Arch/Quad or Tooth Number per line but may not enter both.

• Tooth Number: The Tooth Number populated from the adjacent pop-up. You may enter either an Arch/Quad or Tooth Number per line but may not enter both.

• Req'd Times: The requested units of service.

• Req'd Amount: The requested dollar amount of service.

• More Details: This field navigates you to the More Details view of the line.

• Remove: This field removes the line from the request.

More Details

The More Details view of a line provides a mechanism for you to add more detailed information about a requested line. The component displays the following fields:

• Line, Service Date, Proc & Modifier, Arch/Quad, Tooth Number, Req'd Times, Req'd Amount: These fields display the information that was entered on the previous page. The data may not be modified from this tab.

Attachments

This group allows you to apply attachments to a line. The Enter More Attachments link allows for the entry of 5 additional attachment fields.

• Copy Attachments from Line: Allows you to apply attachments used in another line to the current line.

• Type: This field may be populated by using the associated pop-up and identifies the type of attachment.

• Transmission Code: This field may be populated by using the associated pop-up and identifies the method by which the attachment will be transmitted to eMedNY.

• Control Number: This field identifies the attachment's control number in your records. It is an internal number that is for the provider's office use only and does not correspond to the subsequent PA number issued by NYS Medicaid.

• Description: This field describes the attachment.

Comments

The Comments field allows you to enter free form text that clarifies the request. You may copy comments into the current line from another line in the current PA.

After you have completed the additional items for the current line, choose Close to save the information and return to the previous page. If you wish to abandon the additional items for the current line, choose Clear and you will return to the previous page.