Oregon  |  Fall 2017
Individual dental plans for 2018
Effective Jan. 1, 2018, Delta Dental of Oregon will not offer a Premier plan option for members enrolled in individual plans. Members currently enrolled in individual plans were notified of these changes and given the option to switch plans or cancel their coverage. Those currently on a Premier plan were sent a letter that they will be moved to a Preferred Provider Option (PPO) plan. Delta Dental of Oregon will continue to offer Premier plans outside of the individual market.
View the 2018 benefit plan summaries at modahealth.com/shop/learning-center/our-2018-plans . To review the PPO fee schedule, please contact our Dental Professional Relations team at dpr@modahealth.com  or call 888-374-8905.

OEBB members may now qualify for enhanced benefits

We are excited to welcome each office that has registered for PreViser and has started conducting clinical risk assessments for your Delta Dental of Oregon patients. OEBB members are now eligible to qualify for enhanced benefits if they complete an assessment that results in a high-risk score.
Our Dental Professional Relations representatives, Kristin Nistler and Elizabeth Gordon, EPDH, are available to answer any questions about this program and help you easily integrate it into your daily routine. For questions or if you would like to schedule a training, please call 844-663-4433 or email kristin.nistler@modahealth.com. Learn more at deltadentalor.com/oralwellness/providers.
Submit all dental claims for our records

As a reminder, no matter which dental plan you are submitting a claim for (Delta Dental Premier, Delta Dental PPO, OHP or The Children's Program) please make sure to submit claims for all services provided even if there is no charge for the treatment. This helps us keep an internal record of the dental services provided to our members. For OHP claims, this is a requirement and helps us provide accurate data to the state of Oregon and Coordinated Care Organizations (CCOs) that we partner with for dental services.
For questions about submitting dental claims, please contact our Dental Customer Service team at 877-277-7280.
Q&A: CAREAssist partnership

Delta Dental of Oregon is excited to continue our partnership with CAREAssist in 2018. CAREAssist, whose clients are enrolled in the Individual Delta Dental PPO plan, pays the member's responsibility for services covered by the plan.
We thought it would be helpful to provide a Q&A on how our CAREAssist partnership works.
Q: How does billing work for dental claims?
A: Providers bill Delta Dental just as they would for any other patient. Delta Dental processes the claims against the Individual Delta Dental PPO Plan provisions.

Delta Dental then processes the member's responsibility on behalf of CAREAssist. Providers submit only one bill.
CAREAssist will pay the balance on a procedure as long as Delta Dental pays a portion. If Delta Dental doesn't pay, CAREAssist won't pay either. For example, if a client gets a filling before the six-month waiting period is up and there is no benefit paid, the client will be responsible for the full balance.
For questions about how to bill Delta Dental of Oregon appropriately, please contact our Dental Customer Service team at 877-277-7280.
Update to D4910 processing policy

Delta Dental's national processing policies include a standard policy that disallows D4910 when submitted by the same provider within three months of procedure codes D4210-D4212, D4230-D4231, D4240-D4241, D4245, D4249, D4260-D4268, D4270, D4273-D4278, D4283 and D4285. Delta Dental of Oregon adopted this policy earlier this year.
If D4910 is submitted within three months of one of the above periodontal therapy codes by the same provider, we will disallow as provider write-off with explanation code 90A - Included in fee for periodontal therapy.
If D4910 is submitted within three months of a periodontal therapy code by a different provider, we will allow. However, frequency limitations will apply.
Thanks for your response
We appreciate each dental office that responded to our dental provider accuracy update request. Your participation is very important to helping us meet our goal of 100 percent accuracy and provide our members with access to the highest quality of dental care throughout the state.
Provider Handbooks

503-265-5720 | dpr@modahealth.com | modahealth.com
601 S.W. Second Avenue
Portland, OR 97204