Attention Orthodontic Providers Upcoming Policy Changes for Orthodontic Prior Approvals

Effective Jan. 1, 2024, required records for orthodontic prior approval (PA) requests, including photos of plaster, stone, or resin (3D printed) models, must be attached to the PA segment by the provider directly in the NCTracks Provider Portal.

Supporting PA information will no longer be accepted by mail or fax unless directed by DHB or GDIT staff. This information includes models, medical necessity documentation and responses to requests for additional information.

For providers using iTero/OrthoCAD technology to submit models, NO CHANGE to the current submission process is needed. This is the state’s preferred submission method for models.

In preparation for the mandatory electronic submission, NCTracks has created a new attachment type of MODELPHOTO to be used for the photo submission of models. Beginning Sept. 1, 2023, orthodontic providers not using iTero/OrthoCAD to submit digital models can use the new MODELPHOTO attachment type in lieu of mailing plaster, stone, or resin (3D printed) models.

Qualifying criteria for the requested orthodontic service should be shown clearly in the photos (see example photos below). The photos of the plaster, stone, or resin (3D printed) models should include the following views:

  1. Frontal Occluded
  2. Palatal Occluded
  3. Left Occluded
  4. Right Occluded
  5. Maxillary Occlusal
  6. Mandibular Occlusal

The NCTracks training team is offering a training course covering Dental and Orthodontic Prior Approval Requests, including example photos, on September 21 from 1-3 p.m. EST.

This course will be offered again in October. The date and time of the October course has not been determined. This information will be communicated when it becomes available.

Providers are encouraged to register for this course in SkillPort, the NCTracks Learning Management System. Log onto the secure NCTracks Provider Portal and click Provider Training to access SkillPort. Open the folder labeled Provider Computer-Based Training (CBT) and Instructor Led Training (ILT). The course can be found in the sub-folder labeled ILTs: Remote via WebEx. The course will be conducted over Zoom. 

Example Model Photos: