Claims/Billing
Important Update: Administrative System Enhancement
ODS is currently in the process of enhancing our administrative system. This enhancement will result in greater flexibility and increased productivity, allowing us to continue to deliver high-quality, prompt service. Groups will be moved to the enhanced system in three phases, the first of which began in December of 2006. More...
Tips
Helpful hints to reduce claims processing time!
- Submit claims electronically. ODS processes electronic claims first each day.
- If submitting paper claims, please use standard ADA form typed or legibly printed.
- Verify the patient's relationship to subscriber and plan information is correct before submitting claims.
- Include all pertinent information: subscriber ID or recipient ID (if OHP), patient name and date of birth, tooth number (s) or quadrant, and current ADA codes.
Your office can call the ADA at 1-800-947-4746 to order the most current CDT codebook. - Please do not send x-rays unless requested by ODS. In some instances, clinical information may assist in determining benefits.
- If the patient is covered by more than one ODS program, submit one claim form indicating the name of the subscriber, subscriber ID number, employer (if applicable), and ODS group number for both plans. If covered by another carrier, indicate the above information plus the name, address and policy number of the other carrier.
If a patient has primary insurance through another carrier other than ODS, the EOB of primary payment amount from the other insurance company will need to accompany the claim for consideration of payment. - ODS makes payment twice per month.
- Please contact us before submitting duplicate claims:
- Check Dental Benefit Tracker to see the status of a claim. If you haven't registered for this free online service, click here for more information.
- If you receive a PDR indicating that your claim has already been processed before you receive a check, this indicates your re-bill was unnecessary. Claim was processed and is pending for the next scheduled payment date.
- Re-billing without contacting us slows our turnaround time and delays payment.
- Use miscellaneous codes appropriately with clinical information.
- Code "R8" on the Payment Disbursement Register is for charges exceeding the amount allowed. This is a provider discount and should not be billed to the patient.
- DO NOT USE HIGHLIGHTER ON PAPER CLAIMS.
Clinical Information for Consultant Review
- This file contains guidelines for submission on certain Dental procedures.
Clinical Information for Consultant Review (PDF File)
Electronic Claims and Other Transactions
- ODS is very interested in receiving claims electronically.
- The advantages for your office include:
- The claim reaches ODS quickly, usually anywhere from seconds to 24 hours, depending on connection.
- Lower administrative costs for your office and ODS.
- Because electronic claims require consistent, accurate information, the incidence of returning claims to your office is reduced.
- ODS gives priority to paying electronic claims.
- 60% of the dental claims volume comes to ODS electronically.
- 40% of electronic claims are processed within 24 hours of receipt.
Below is a list of Dental Electronic Claims Providers for ODS
Clearinghouses
- APEXEDI Inc.
922 S. Main
Pleasant Grove, UT 84062
801-642-0285 - EDI Health Group (EHG)
2201 Dupont Dr. #650
Irvine, CA 92614
949-852-0825 - TESIA – PCI Corporation
3500 Sunrise Hwy #T-208b
Great River, NY 11739
630-922-6317
Practice Management Systems that submit directly to ODS
Direct Connection to ODS
ODS also supports direct connections between offices and ODS if the dentist prefers this method.
Transaction standard is the 837 Dental Claim required by HIPAA Administrative Simplification.
If you have questions, please call Pat Van Dyke at 503-243-4492 or 1-800-852-5195 extension 4492.
ODS EDI Transactions Contacts
- For 835-Electronic Remittance Advice/ Electronic Funds Transfer
Lan Nguyen, (503) 265-5632, - For 837- Claims
Arlene Gaddi, (503) 265-5619, - For 834-Enrollment, 270/271- Eligibility and Benefits, 276/277-Claim Status
Kathy Turner, (503) 243-4487,
Dental Pre-Determinations
- Pre-determinations are not required, but are recommended for extensive treatment.
- Submit pre-determinations electronically.
- The treatment form should be partially completed for pre-determination of benefits:
- Check the block for "Dentist's pre-treatment estimate".
- Appointment dates should not be shown.
- The Dentist's signature is not required.
- Please use ADA codes for all procedures.
- Include any clinical information that may be helpful in determining benefits:
- Often, the written description is more informative than x-rays.
- Clinical information can also be useful when submitting unusual claims.
- Do not submit x-rays with the pre-determination, unless requested by our Dental Consultant. Special handling is required for x-rays, which will slow the claims process.
- Include complete descriptions, valid ADA codes, tooth numbers.
- Use correct ID numbers: Subscriber ID number for commercial and recipient ID number for Oregon Health Plan.
- Type or legibly print pre-determinations.
- Watch for correct patient to subscriber relationship.
Support for claims from other Deltas
For help with claims from other Deltas, please contact that Delta directly.