Dear ODS Dental Medicaid Provider,

Greetings from ODS Community Dental!

We are taking this opportunity to share some annual reminders to help you as you provide services to our dental Medicaid members.


Please review this helpful information with your office team. Contact ODS dental customer service at 800-342-0526 if you have any questions or need further clarification about these annual reminders.


We want to thank you for providing quality dental services for our mutual ODS dental Medicaid members.
Financial waiver for non-covered services
As an OHP provider you are required to inform your ODS patients of any charges for non-covered services prior to services being delivered. Your patient cannot be held financially responsible for services that are not covered by ODS and/or services that have been denied due to provider office error. If your patient chooses to receive a specific service that is not covered by ODS, you will need to make arrangements with your patient  prior to rendering the services.

Helpful reminders when speaking to your patient-
1. Inform your patient that the service is not covered.
2. Provide an estimate of the cost of the service.
3. Explain their financial responsibility for the service.
4. Complete the OHA Patient Responsibility Waiver (must be signed by member prior to rendering services).

Click here to access the OHA Patient Financial Responsibility Waiver. It is important that you always use this OHA form, your office financial agreement will not suffice.
ODS has entered into capitation agreements with several OHP providers throughout Oregon. Members assigned to a dental office must receive dental services at this office.

When verifying eligibility in Benefit Tracker navigate to Group Limitations to check member assignment.

Questions about Benefit Tracker? Call 877-337-0651.

We recently sent a letter to our OHP providers regarding capitation agreements and member assignment.

Click here access the May, 2019 provider letter and FAQ.
Interpreter services
Does your patient need interpreter services for their scheduled dental appointment?

ODS coordinates and pays for interpreter services for appointments for OHP members. To arrange for interpreter services, complete the ODS Interpreter Request form and fax it to ODS at 503-952-5259 no less than 48 hours prior to the appointment. Contact ODS Customer Service at 800-342-0526 to confirm an interpreter has been arranged. Prior to requesting interpreter services please make sure the appointment is for OHP covered services.

For urgent needs (less than 48 hours notice), it is best to call ODS customer service at 800-342-0526 to arrange for an interpreter.  
Click here to access the ODS Interpreter Request form.
Missed appointments
We understand the challenges you face when your patients miss their appointments either by short notice cancellation or failing to appear for a scheduled appointment.

We recommend you establish a missed appointment office policy that applies to all patients in your practice. The policy should indicate the number of missed appointments you allow before dismissal from your practice. Best practice suggests you advise your patients of this policy at their first visit and ask them to sign an acknowledgment of the policy.

When your ODS patient misses an appointment we suggest you contact the member to reschedule and also notify ODS customer service of the missed appointment by completing and submitting the ODS Missed Appointment form. ODS Customer Service will contact the member to educate them on the importance of keeping appointments and the expectation to provide advance notice of cancellation.

If your patient violates your missed appointment policy and you elect to dismiss, you must send a letter of dismissal to your patient informing them of the dismissal. A copy of the dismissal letter accompanied by your office policy and any additional supporting documentation should be submitted to ODS customer service .
ODS customer service will help the member find a new dentist and will also track future missed appointment history that may ultimately result in dismissal from the ODS OHP plan.
Click here for a copy of the missed appointment form.
Mail to 601 SW 2 nd Ave Portland, OR 97204, fax 503-952-5259, email [email protected]
Member rights and responsibilities

The Oregon Health Authority publishes OHP member rights and responsibilities in the Administrative Rulebook. For your reference we have included this information in this newsletter.

MEMBERS HAVE THE RIGHT TO:
  1. Be treated with dignity and respect.
  2. Be treated by participating providers the same as other people seeking dental care benefits to which they are entitled.
  3. Select or change primary care dentists (PCD).
  4. Have a friend, family member or advocate present during appointments and at other times as needed within clinical guidelines.
  5. Be actively involved in creating treatment plans.
  6. Be given information about conditions, covered services and non-covered services in order to make an informed decision about proposed treatment(s).
  7. Consent to treatment or refuse services and be told the consequences of the decision, except for court-ordered services.
  8. Receive written materials describing rights, responsibilities, benefits available, how to access services and what to do in an emergency.
  9. Have written materials explained in a manner that is understandable.
  10. Receive necessary and reasonable services to diagnose the presenting condition.
  11. Receive covered services under the Oregon Health Plan that meet generally accepted standards of practice and are medically appropriate.
  12. Receive covered preventive services.

MEMBERS HAVE THE RESPONSIBILITY TO:
  1. Choose, or help with, assignment to a provider or clinic, once enrolled.
  2. Treat all providers and their staff with respect.
  3. Be on time for appointments made with providers and call in advance either to cancel if unable to keep the appointment or if expected to be late.
  4. Seek periodic dental exams, check-ups and preventive care from the member’s dentist.
  5. Use the member’s dentist or clinic for diagnostic and other care except in an emergency.
  6. Obtain a referral to a specialist from the general dentist before seeking care from a specialist.
  7. Use urgent and emergency services appropriately and notify ODS within 72 hours of an emergency.
  8. Give accurate information for the clinical record.
  9. Help the provider obtain clinical records from other providers. This may include signing a release of information form.
  10. Ask questions about conditions, treatments and other issues related to their care that they do not understand.
  11. Use information to decide about treatment before it is given.
  12. Help in the creation of a treatment plan with the provider.
  13. Follow prescribed, agreed-upon treatment plans.
  14. Tell providers that the member’s dental care is covered under the Oregon Health Plan before services are received and, if requested, show the provider the Division Medical Care identification form.
  15. Tell the authority worker of a change of address or phone number.
  16. Tell the Authority worker if she becomes pregnant and notify the Authority worker of the birth of the child.
  17. Tell the Authority worker if any family members move in or out of the household.
  18. Tell the Authority worker if there is any other insurance available.
  19. Pay for non-covered services received under the provisions described is OAR 410-120-1200 and 410-120-1280.
  20. Pay the monthly OHP premium on time if so required.
  21. Assist in pursuing any third-party resources available and to pay ODS the amount of benefits paid from an injury from any recovery received from that injury.
  22. Bring issues, complaints or grievances to the attention of ODS.
  23. Sign an authorization for release of dental information so that ODS can get information pertinent and needed to respond to an administrative hearing request in an effective and efficient manner.