Oregon Health Plan

Oregon Dental Service is always welcoming more Oregon Health Plan providers.

Providers can limit the number of patients they see to just a few or even one patient.
Providers can request that their name not be listed in the directory.
Please notify us in writing when limiting your practice for new OHP patients.

New MMIS Eligibility System and Training
OHP Provider Announcements
Member Handbook

ODS Oregon Health Plan offers translation services for OHP members and providers. Please call Customer Service two working days before an appointment. We will need the following information:

Date and time of appointment
Type and length of appointment
Dentist name, address and contact person
Patient name and contact telephone number
Language needed
Note: two weeks notice for sign interpretation

If your patient requires a referral to a specialist, Customer Service needs the following information:

Type of services needed: ENCC, Endodontics, Oral Surgery, Pediatric
Current dentist name and telephone number
Patient's name, ID number, and contact telephone number
Travel or appointment limits
Patient special needs

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 in posterior teeth will be allowed at the amalgam fee. Use codes 02380 through 02387.

Since ODS Oregon Health Plan patients may change dentists you may contact Customer Service for time limits on exams, x-rays, etc.
If there is a delay in claim payment, please call Customer Service before resubmitting the claim.
Exams and cleanings are allowed once every 6 months.
Routine bitewing x-rays are allowed once every 12 months. Full mouth or Panoramic films are allowed once every 36 months.
The plan will provide coverage for partials & dentures, however, the patient must be at least 16 years old. Limited to once every 5 years.
Permanent crowns are allowed for anterior permanent teeth only once every 5 years.
Stainless steel crowns are allowed for posterior permanent teeth once every 5 years.
Often the dental consultant will ask for a clinical narrative. It is very important to submit the clinical information requested when pre-determining services.
ODS recommends pre-determining any major services.
X-rays will be requested as needed. Please do not submit until ODS requests them.
Timely filing requirements is 15 months from the date of service.
Request a copy of their active ID card or call Customer Service to verify eligibility.