Please Use the Correct Form for Dental PA

Some dental and orthodontic providers have been submitting their prior approval (PA) requests on the DMA 372-118 form which is the "NC DMA Request for Prior Approval" form. This form is for medical providers. Since the NC Tracks go live on July 1, 2013, there has been no change for dental or orthodontic providers submitting prior approval requests on paper via mail or fax. Dental and orthodontic providers are still required to use the 2006 ADA form.

If a dental or orthodontic prior approval request is sent to NC Tracks using the DMA 372-118 form for medical providers, the prior approval will be routed to the medical prior approval review location in NC Tracks. This will delay the review of the prior approval.

Of course, providers are strongly encouraged to use the web portal to submit PAs and additional information rather than mailing or faxing. However, if submitting a paper form, please submit dental and orthodontic paper prior approvals (fax or mail) on the 2006 ADA form.