Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
www.mass.gov/dma	
	MassHealth
	Dental Bulletin 30
	December 2003

	TO:	Dental Providers Participating in MassHealth

	FROM:	Beth Waldman, Acting Commissioner

	RE:	Supplemental Dental Prior Authorization Form

Background 	The Division has revised the Supplemental Dental Prior Authorization Form (DEN-1) in an effort to simplify the prior-authorization process.

Phasing in and Obtaining	A copy of the revised form DEN-1 is attached.  Please note:  the 
the New Form	Division will continue to use and distribute the previous version of DEN-1 (Rev. 08/02) until its supply of the form is exhausted.  To obtain supplies of the form, by mail or fax a written request to the following address or fax number.

			MassHealth
				Forms Distribution  
				P.O. Box 9101
				Somerville, MA  02145
				Fax: 617-576-4087
	
	DEN-1 (Rev. 12/03) is also available on the Division’s Web site at www.mahealthweb.com. 

Important Documentation	Please note that providers are responsible for all information submitted for both prior authorization (PA) and furnished services.  Providers must document that they have examined the member and reviewed and verified the accuracy of the information provided on the PA form.

Electronic Options	In the near future, the Division will offer providers the option to submit a request for PA via APAS (Automated Prior Authorization System).  The Division provides more information about this new technology and its capability to include submitting and tracking requests on-line at www.masshealth-apas.com.  

Questions 	If you have questions about this bulletin, please contact MassHealth Provider Services at 617-628-4141 or 1-800-325-5231.