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Medical Clearance for General Anesthesia or IV Sedation for Dental Procedures

Dental providers can use this form to obtain feedback from an Alliance member’s primary care provider (PCP) regarding the use of general anesthesia or IV sedation for dental procedures.

Nias daim duab nram qab no los qhib daim ntawv PDF:

Contact Provider Services

General	831-430-5504
Cov Kev Thov Billing questions, claims status, general claims information	831-430-5503
Authorizations General authorization information or questions	831-430-5506
Authorization Status Checking the status of submitted authorizations	831-430-5511
Lub Tsev Muag Tshuaj Authorizations, general pharmacy information or questions	831-430-5507