Form 6504 Prior Authorization for Dental Services - Texas

Form 6504 Prior Authorization for Dental Services - Texas

What Is Form 6504?

This is a legal form that was released by the Texas Health and Human Services - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form 6504?
A: Form 6504 is a Prior Authorization for Dental Services form used in Texas.

Q: Why is a prior authorization required for dental services?
A: Prior authorization is required to ensure that dental services meet specific criteria and are medically necessary.

Q: Who needs to complete Form 6504?
A: Dentists or dental providers in Texas need to complete Form 6504.

Q: What information is required on Form 6504?
A: Form 6504 requires information about the patient, the requested dental services, and supporting documentation.

Q: How long does it take to process a prior authorization?
A: The processing time for a prior authorization can vary, but it is typically within 14 calendar days.

Q: What happens after Form 6504 is submitted?
A: After Form 6504 is submitted, it will be reviewed by the dental benefits administrator to determine if prior authorization is granted.

Q: Can Form 6504 be submitted electronically?
A: Yes, Form 6504 can be submitted electronically through the TMHP provider portal.

Q: What should I do if my prior authorization request is denied?
A: If your prior authorization request is denied, you have the right to appeal the decision and provide additional supporting documentation.

Q: Is prior authorization required for all dental services?
A: No, not all dental services require prior authorization. Only certain procedures or treatments specified by the dental benefits administrator may require prior authorization.

ADVERTISEMENT

Form Details:

  • Released on July 1, 2010;
  • The latest edition provided by the Texas Health and Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form 6504 by clicking the link below or browse more documents and templates provided by the Texas Health and Human Services.

Download Form 6504 Prior Authorization for Dental Services - Texas

4.8 of 5 (23 votes)
  • Form 6504 Prior Authorization for Dental Services - Texas, Page 1
ADVERTISEMENT

Related Documents