Required information when submitting ADA forms for NC Health Choice

When mailing or faxing an American Dental Association (ADA) form for NC Health Choice, you must:

- Mail all NC Health Choice prior approval requests separately. Do not send them mixed with Medicaid prior approval requests.

- Write “NC Health Choice Dental� or “NC Health Choice Orthodontics� in BOX 3 on all mailed or faxed ADA claim forms

- Write on outside of the mailing envelope - Attn: NC Health Choice Dental or Attn: NC Health Choice Orthodontics

- Have a provider signature in BOX 53 on all mailed or faxed requests.