Dental prior authorization checklist

Published and verified: June 6, 2026 · Adapt each step to the member's current plan

1. Member and plan scope

• Confirm active eligibility and the exact plan/product.
• Confirm the state program and dental benefit administrator.
• Confirm whether prior authorization, predetermination, or documentation with claim is required.

2. Procedure and billing path

• Confirm the CDT code, tooth, quadrant, arch, and units.
• Confirm the correct billing and rendering provider information.
• For FQHC cases, verify whether the program requires a professional claim or another FQHC-specific path.

3. Clinical evidence

• Clinical notes explain the diagnosis, findings, and medical necessity.
• Radiographs, photographs, periodontal charting, and treatment history are current and legible when required.
• The narrative and attachments support the exact procedure and location submitted.

4. Benefit and policy checks

• Check frequency, replacement, age, history, bundling, and prerequisite rules.
• Check whether emergency and routine requests follow different documentation timing.
• Record the source title, effective date, and date verified.

5. Final submission control

• All required fields and attachments are present.
• The submission channel and contact information match current payer instructions.
• A coordinator can explain what is being requested, why, and what source was checked.

Primary sources used to shape this workflow

• DentaQuest Texas: Prior Authorization Process — distinguishes pre-treatment documentation from documentation with claim.
• LIBERTY Dental Plan: New York State Prior Authorization Checklist — demonstrates procedure-specific clinical and history requirements.
• Ohio: FQHC Dental Prior Authorization Submission Quick Reference Guide — demonstrates FQHC-specific submission-path checks.