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Reminder About Orthodontic Prior Authorization Information posted July 15, 2011 Prior authorization is required for all Texas Health Steps (THSteps) orthodontic services except for procedure code D8660. The THSteps Dental Mandatory Prior Authorization Request Form must contain the date of service on which the orthodontic diagnostic tools were produced. If the request is approved, the date that the records were produced is considered to be the start date of the orthodontic authorized period. Note: For group providers, if the Texas Provider Identifier (TPI) of the group is included as the performing provider on the THSteps Dental Mandatory Prior Authorization Request Form, any performing provider within the group who is skilled in the authorized service can see the client. If the TPI of an individual performing provider is included on the form, only that provider can see the client. The client must be eligible for Medicaid and THSteps when authorization is requested and also when the orthodontic treatment plan is initiated. If banding is initiated after the loss of eligibility, claims will be denied, and the treatment will not be considered by Medicaid. Banding must have been initiated before loss of eligibility for the treatment to be considered to completion. It is the provider’s responsibility to determine whether the client is eligible by checking one of the following: The client’s Your Texas Benefits Medicaid Card The client’s current Medicaid Identification Form (Form H3087) or Medicaid Eligibility Verification Form (Forms H1027 and H1027-A-C), and the date of birth on the form must indicate that the client is 20 years of age or younger and that no limitations are indicated Prior authorization is a condition for reimbursement; it is not a guarantee of payment. For more information, call the TMHP Contact Center at 1-800-925-9126.