Dental

WSI requires prior authorization for the following dental services:
  • Restorative fillings, crowns, bridges, and veneers
  • Dentures and implants including: partial or impartial and fixed or removable
  • All dental surgical procedures, whether performed in the office or outpatient setting, including: endodontics, periodontics, oral and maxillofacial surgery

A dental provider should also refer to the Utilization Review Guide, which outlines WSI's authorization requirements for other medical services such as advanced imaging, prosthetics, durable medical equipment, etc.

Submitting a Prior Authorization Request

Appealing a Prior Authorization Denial

To appeal a denied prior authorization request, complete the Medical Service Dispute Resolution Request (M2) form and fax with additional documentation of medical necessity to 888-786-8695.