Oregon  |  Spring 2017
Introducing a new dental plan design
We are excited to share details about a new Delta Dental plan design called PPO MAC (Maximum Allowable Charge) plan. A MAC plan is a Delta Dental PPO (Preferred Provider Organization) plan that reimburses Preferred and Premier providers at the PPO fee schedule. A MAC plan differs from a traditional PPO plan because it allows Premier providers to balance bill the difference between their PPO fee and their filed fee. Adding this MAC plan to our dental products ensures a more competitive portfolio and offers another option for our employer groups. In addition, the premium for a MAC plan is less costly than Delta Dental of Oregon's traditional PPO plan and could offer cost savings to the member when dental services are performed by a PPO provider.
  
The grids below show the provider's network and fee administered for a MAC plan compared to a traditional PPO plan.
 
MAC plan:
Provider Network:
PPO Fee
Filed Fee
Non-Par Rate
Can provider balance bill?
Preferred Provider
(in-network)
X


No
Premier Provider
(out-of-network)
X


Yes - The difference between PPO fee and filed fee
Non-Participating Provider (out-of-
network)


X
Yes - The difference between non-par rate and billed charge

Traditional PPO plan:
Provider Network:
PPO Fee
Filed Fee
Non-Par Rate
Can provider balance bill?
Preferred Provider (in-network)
X


No
Premier Provider (out-of-network)
X

No
Non-Participating Provider (out-of-network)

X
Yes - The difference between non-par rate and billed charge

You will be able to identify a member with a PPO MAC plan by the Insurance Type displayed in Benefit Tracker.  The Insurance Type will read - Delta Dental PPO - MAC plan (it's important to take note of the member's Insurance Type in Benefit Tracker since their member ID card will show the network as Delta Dental PPO without the MAC plan identifier).



Also, when you select Group Limitations, you will see a disclaimer under the Benefits section confirming that the member is on a MAC plan.

ADA adopts multi-tiered policy on opioids

Last October, the ADA House of Delegates passed Resolution 64H-2016, an ADA Statement on Use of Opioids in the Treatment of Dental Pain.

The American Dental Association (ADA) has published the following article on this policy, which includes recommendations for dentists: www.ada.org/en/publications/ada-news/2017-archive/january/ada-adopts-multitiered-policy-on-opioids .

To learn more on all of the ADA activities on opioids, please visit ADA.org/opioids.
Tips to expedite claims processing

When billing for procedures in multiple quantities, such as periapical x-rays or units of anesthesia, please create separate line items on the dental claim form. This will help ensure that all of the covered treatment is considered. Our system does not currently recognize the quantity, Box 29b of the 2012 ADA claim form, and will default to only allowing one unit if not listed individually. 
New ODS OHP dental support services

To better serve your patients, you need quick access to current patient information. Our dedicated ODS OHP dental support teams are ready to answer your questions and provide you with the information you need, when you need it.
 
Dental Customer Service
For assistance with member eligibility, claims status, interpreter requests and benefits:
Phone: 800-342-0526
Fax: 503-765-3297
 
ODS Dental Case Management
For assistance with coordination for members with special needs and other special treatment services:
Phone: 844-274-9124
Fax: 503-952-5259
 
Dental Professional Relations
For assistance with contracts, credentialing and ODS provider directory listings:
Phone: 888-374-8905
Fax: 503-243-3965
 
Additional resources
Current ODS OHP forms:
2017 OHP Dental Provider Handbook:
 
As a valued partner of the Moda, Inc. family, we look forward to working with you and your team to continue bringing excellent dental care to people all over Oregon.

Provider Handbooks
 

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