MedicaidCoverageHigh impact
ForwardHealth Update 2025-29: Severe Malocclusion Policy Clarification
Wisconsin ForwardHealth·WI · Dentistry, Oral & Maxillofacial Surgery·Medical Policy
Effective date
Oct 31, 2025
We identified it
Jun 18, 2026
Summary
ForwardHealth is replacing the Salzmann Index scoring system with new orthodontic automatic qualifiers (AQs) to determine medically necessary orthodontic care for severe malocclusions. The new criteria include specific conditions like cleft palate, severe overjet, crossbites, and skeletal malocclusions that automatically qualify for coverage.
Action Required
By October 31, 2025: Billing team must update orthodontic prior authorization processes to use new automatic qualifiers instead of Salzmann Index scores. Update documentation requirements to include clinical narratives for open bite cases and specialist descriptions for craniofacial anomalies. Train staff on new AQ criteria including overjet measurements, crossbite counts, and spacing/crowding thresholds. Ensure proper documentation retention per Wisconsin Admin Code requirements as claims may be audited and denied without proper supporting documentation.