Oregon Health Plan
Oregon Dental Service is always welcoming additional Oregon Health Plan providers.
- As an OHP provider you may limit the number of patients you accept into practice or you may adjust the number of patients you currently accept into your practice.
- Providers can request their name be excluded from the directory.
- Please notify us when limiting your practice for new OHP patients.
New MMIS Eligibility System and Training
OHP Provider Announcements
Member Handbook
OHP Provider Handbook
ODS Oregon Health Plan offers language translation services for OHP members. Notification of two business days before an appointment is requested for language translation and two weeks notice for sign interpretation. Please call Customer Service and provide the following information:
- Date, time and length of appointment
- Type of appointment
- Dentist name, contact name and address
- Patient name, ID number and contact telephone number
- Language needed
If your patient requires a referral to a Specialist, the following information is needed:
- Service type (Endodontics, Oral Surgery, Pediatric or Special Needs). To ensure the patient is referred to the appropriate Specialist, indicate any special needs or concerns the member has.
- Current dentist name and telephone number
- Patient's name, ID number, and contact telephone number
- Travel times
- Sedentary limits
- ODS Oregon Health Plan no longer allows benefits for services that are "buy-ups" from allowed services. For example, an additional client payment to obtain a gold crown (not covered) instead of the stainless steel crown (covered).
Exception: Composite or similar restorations on posterior teeth will be allowed at the amalgam fee.
- Since ODS Oregon Health Plan patients may change dentists, we recommend you contact Customer Service for limitations.
- If there is a delay in claim payment, please call Customer Service before resubmitting the claim.
- Exams and prophylaxis are allowed twice in a 12 month period.
- Routine bitewing x-rays are allowed once in any 12 month period.
- Full mouth or panoramic films are allowed once every 3 years.
- The plan will provide coverage for partials & dentures; however, the patient must be at least 16 years old. Partials are limited to a 10 year replacement. Dentures are allowed once per lifetime for non-pregnant members age 21 and older. Patient must have history of an extraction within 3 months of the appliance insert (seat date). Dentures are allowed once every ten years for members age 16-20 and/or who are pregnant.
- Permanent crowns are allowed only for the following anterior permanent teeth (6, 7, 8, 11, 12, 22, & 27) once every 7 years. A maximum of 4 crowns are allowed a benefit within a 7 year period.
- Stainless steel crowns are allowed for posterior teeth for member under age 21 and/or who are pregnant.
- Clinical narrative and/or x-rays may be requested for some services. It is recommended that you do not submit x-rays unless requested.
- ODS recommends a predetermination for all major services.
- Timely filing requirement is 15 months from the date of service.
- Request a copy of the member’s active ID card and call Customer Service to verify eligibility.