Effective 08/10/2021 –  The number of additional prophies approved for the current calendar year will be calculated based on the date of the first Prophy and MRC submitted on the questionnaire. The approved dates will be backdated to January 1st of the current year to allow for the authorization to be used for retrospective D1110 for the CURRENT calendar year.

Example:

1st Prophy date 08/02/2021, 3 MRC, 2 calendar year(s).

1 additional D1110 approved for the period 01/01/2021 to 12/31/2021. 3 additional D1110 approved for the period 01/01/2022 to 12/31/2022.

Reminder: Submit D1110 requests independent of other Dental Requests. D1110 requests submitted for auto-approval will receive authorization within 2 business days and for up to 2 calendar years.

PLEASE NOTE: Retrospective requests for the PRIOR calendar year must be submitted on a separate case.