Dental services are a covered benefit for New Mexico Medicaid recipients. Dental services include specific diagnostics, preventive, or corrective procedures to the teeth.
The New Mexico Human Services Department contracts with Molina Healthcare Third-Party Assessor (TPA) to conduct prior authorization reviews for fee-for-service dental services. Molina Healthcare TPA subcontracts fee-for-service dental reviews to DentaQuest.
Prior authorization requests must be submitted to DentaQuest and accompanied by the appropriate documentation and required clinical material, such as x-rays, charting, and study models for orthodontia. Prior authorization requests are submitted on the ADA form (appropriate ADA codes and tooth numbers/quadrants must be indicated). The NM Handicapping Labio-Lingual Deviations form can be accessed here
All requests are reviewed by peer consultants (i.e., dentists and/or orthodontists). To learn more about DentaQuest, click here
Requests for dental prior authorizations are mailed to:
DentaQuest of New Mexico, LLC
12121 N. Corporate Parkway
Mequon, WI 53092
Phone: (800) 341-8478
Fax: (262) 834-3589
Dentists who are also contracted with DentaQuest for managed care members may submit prior authorization requests via the DentaQuest web portal.
For dental authorization inquiries, please contact the Molina Healthcare TPA Dental Care Coordinator toll-free at: (800) 580-2811, ext. 180262 or in Albuquerque at (505) 348-0262.