Oregon  |  Summer 2017
Help patients achieve optimal oral health
When it comes to oral health, we know that some people need more care than others. That's why Delta
Dental of Oregon offers Health through Oral Wellness, a program that provides extra benefits and related care to patients who are at greater risk for oral diseases.

Determined by a clinical oral health risk assessment, your patients may be eligible for enhanced benefits
that include extra cleanings, fluoride treatments, sealants and periodontal maintenance each year.

The program also gives you access to Dentalytics™, an online data analytics tool that allows you to see claims data to track patients with a history of periodontal disease and who are due for their treatment. This information can help you provide evidence-based care to improve your patients' oral health and your bottom line.

To learn more about the program, visit deltadentalor.com/oralwellness/providers/ or call dental provider services toll-free at 844-663-4433.

The enhanced benefit feature of Health through Oral Wellness is available to patients with qualifying
risk assessment scores and whose employers participate in the program. For OEBB members, the program starts Oct. 1, 2017. For PEBB, adidas and ODS-OHP members, the program rolls out on Jan. 1, 2018.

OEBB introduces a new Exclusive PPO plan option

Effective Oct. 1, 2017, a Dental Exclusive PPO plan option will be one of six dental plan options offered to OEBB members. This plan includes a $1,500 annual maximum with a $50 deductible that is waived
on Class I services. Benefits for each class of services include:
> Class I services - 100%
> Class II services - 90%
> Class III services - 80%
The Delta Dental Exclusive PPO plan has no out-of-network benefit. Services performed by providers outside the Delta Dental PPO network are not covered unless for a dental emergency. Covered emergencies consist of a problem focused exam, palliative treatment and x-rays. All other services
are not covered.

To see all OEBB plan options, visit oregon.gov/oha/OEBB/Plans/Dental-Plan-Designs-2017-18.pdf. For
questions, please contact our Dental Customer Service team at 866-923-0410.
Meeting quality measures for children in DHS custody

Through our partnerships with coordinated care organizations (CCO) and our valued OHP providers,
ODS is committed to meeting the Oregon Health Authority's dental quality measures. The dental
measures include dental, physical and mental assessments for children in DHS custody and the application of dental sealants.

To learn more about these measures and to access the CCO 2016 Metrics Final Report, go to

Dental sealants
Dental sealants are a proven and cost-effective method for the prevention of tooth decay. As such, the OHA has chosen to focus this quality metric on children receiving sealants on their first and second
molars. The OHA placed the children in two age groups; 6-9 and 10-14, and will measure claim submissions for children covered under OHP who received at least one sealant in 2017.

Children in foster care
The lack of dental care can have a significant impact on learning, communication, nutrition and other
activities necessary for normal growth and development. With your help, we can provide our Medicaid children and adolescents the care they need by screening kids ages 1-17 in DHS custody within 60 days of being in DHS care and by billing the appropriate codes to monitor their health.

ODS will reimburse the service with the qualifying CDT codes for clinical oral evaluations: D0120, D0140,
D0145, D0150, D0160, D0170, D0180, D0190 and D0191. Please note this assessment must be completed within 60 days regardless of assessments occurring prior to entering DHS care.

This work takes a coordinated care approach. You may receive a call from our OHP dental coordinators
to help facilitate the process for specific cases. If you have any questions, please contact our OHP
dental coordinator at 844-274-9124 or dentalcasemanagement@modahealth.com.

We are continually monitoring our progress with the sealant measure. We ask all of our valued providers and office staff to review the sealant and DHS measures and guidelines. We appreciate all you do to address the oral health needs of Oregon's children.
Timely filing guidelines

Delta Dental of Oregon and ODS Oregon Health Plan (OHP) require that providers bill Delta Dental and ODS OHP directly for services provided to their respective members. Below is a reminder of the timely filing guidelines:

Delta Dental of Oregon
All eligible claims must be received within 12 months following the date of service. Claims that exceed this timely filing limit shall be invalid and not payable, with the exception of employer groups that have selected a different timely filing requirement. Learn more in Benefit Tracker via the Group Limitations link.

All eligible claims must be received within four months following the date of service. Cases that allow
claims must be submitted within 12 months of the date of service are listed in OAR 410-141-3420.
The Children's Program
All eligible claims must be received within three months after the date of service. Claims received later than three months after the date of service shall be invalid and not payable.

Save time and improve patient account identification

Beginning in early August, claim specific overpayment deduction details were added to the Payment Disbursement Register (PDR). They include:
> Original claim ID
> Patient account number
> Original paid date
> Original check number
> Original paid amount
> Previously recovered amount
> Current recovered amount
> Remaining overpayment amount

In addition, 835 electronic remittance advice (ERA) files now include the original claim ID and patient account number. These changes should save time and improve patient account identification when identifying overpayment deductions.

To see a sample PDR, visit modahealth.com/pdfs/pdr_guide_den.pdf. For more information
about your PDR or 835 ERA files, please email dental@modahealth.com or call our Dental Customer Service team at 888-217-2365.

Bend employer group benefits now available online

St. Charles Health System, a new Delta Dental of Oregon customer in the Bend area under group number 10015490, now has their incentive levels available in Benefit Tracker. You may view their benefit information online at any time.

If you have questions, please contact our Dental Customer Service team at 844-746-0584.

Provider Handbooks

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