Network
- What pharmacy network will be used for OEBB members?
- What medical and vision provider networks will be used for OEBB members?
- What dental provider network will OEBB members use?
- How can members find out if their medical provider is in or out of network?
- If a specific clinic is not listed on the ODS website, how can members find out if their provider is part of their new medical network with ODS?
- Can providers be participating even if the clinic they work out of is not?
- What should members do if they look up their provider by both name and specialty and still cannot find him or her listed? Can members nominate a provider to participate?
- Can any provider join the ODS Plus Network?
- How can members find out when a new provider or hospital joins the ODS Plus Network?
- If a provider is added to the network after a member receives services, will ODS reprocess the claim to pay the in-network level?
- What are the names of the major vision chains that ODS contracts with?
- If a member is a retiree or COBRA recipient who resides outside of Oregon, Washington, Idaho and Montana, he or she will use the PHCS network. When these members access this network online, they are required to indicate what logo should be on their ID card. If these members do not have an ID card when logging on, what logo should they click on?
What pharmacy network will be used for OEBB members?
OEBB members will use the Oregon Prescription Drug Plan (OPDP) pharmacy network.
What medical and vision provider networks will be used for OEBB members?
Active employees and their dependents in Oregon, Idaho, southwest Washington and northern California will use either the ODS Plus Network or the ODS Community Care Network.
Retirees, COBRA members and their dependents residing outside the state of Oregon will use the following networks:
- Washington, excluding southwest and south central Washington — First Choice
- Montana — Health InfoNet (HIN)
- All other states — PHCS
Beginning October 1, 2011 all members have access to the ODS Travel Network. The Travel Network allows medical plan members to receive emergency and nonemergency care outside of their primary service area while traveling. Eligible members need to seek care from a PHCS "Healthy Directions" provider, and will receive in-network benefits. The ODS Travel Network is not an alternative primary network. Members must seek in-network services whenever possible, and preauthorization is required for in-patient services.
What dental provider network will OEBB members use?
Active employees, retirees and their dependents will use the ODS Premier Network. This network includes access to the Delta Dental Provider Network nationwide.
How can members find out if their medical provider is in or out of network?
OEBB members have access to either the ODS Plus Network or the ODS Community Care Network. The ODS Plus Network network includes Providence and Legacy Hospitals and physicians, as well as providers contracted in outlier areas. The ODS Community Care network is a concentrated network of provider including Legacy Health, Salem Health and affiliated providers. Retirees may have a different network depending on where they reside (see question 2 above). Members can locate providers in their network by using our online Find Care tool and entering their OEBB ID number.
If a specific clinic is not listed on the ODS website, how can members find out if their provider is part of their new medical network with ODS?
The most effective search process is to search by the provider’s last name or ZIP code because providers with multiple practice specialties may not be listed under all of their specialties. Members can search for their provider by name, specialty, ZIP code or city in which the provider is located. ODS customer service is also available to help members in locating in-network providers.
The most effective search process is to search by the provider’s last name or ZIP code because providers with multiple practice specialties may not be listed under all of their specialties. Members can search for their provider by name, specialty, ZIP code or city in which the provider is located.
Can providers be participating even if the clinic they work out of is not?
Yes. It is possible that a physician is participating in the ODS network even if the entire clinic is not.
What should members do if they look up their provider by both name and specialty and still cannot find him or her listed? Can members nominate a provider to participate?
Yes. Here’s how:
- On the ODS website at the top under the expression "Find Care", click the link "Search for a physician, dentist, pharmacy or clinic"
- Click Nominate for a Medical or Dental provider
- Click Send
- Send an e-mail listing the provider’s first and last names, clinic name and telephone number.
- ODS will contact the provider to determine if he or she is interested in contracting with ODS for the ODS Network. If the provider is interested, a contract will be mailed. The member will be notified via e-mail of the provider’s interest or that he or she has declined.
- Please note: Medical providers may indicate the desire to contract with ODS initially but ultimately choose not to contract for a variety of reasons. A request for a contract does not guarantee provider participation.
- Please note: It takes an average off 30 days for providers to complete the contracting process and an additional 45–90 days to complete the credentialing process.
- Once contracted and credentialed, providers are listed on the ODS website Provider Directory, which is updated daily.
Can any provider join the ODS Plus Network?
Members can nominate any provider to participate in the ODS Plus Network; however, not all providers will qualify or agree to participate. A provider must be licensed and in good standing with his or her appropriate licensure board. In addition, the provider must pass ODS Credentialing Review if required and must agree to and sign an ODS Participating Provider Agreement.
Once the agreement has been signed and received by ODS and the provider has passed the credentialing review, ODS considers the provider participating and he or she is listed in the ODS Plus Provider Directory.
How can members find out when a new provider or hospital joins the ODS Plus Network?
Providers will not be added to the provider directory until they are fully credentialed, which takes an average of 45–90 days after receipt of a signed agreement. For the most up-to-date information, members can continue to review the ODS Plus Network online via the ODS website.
If a provider is added to the network after a member receives services, will ODS reprocess the claim to pay the in-network level?
No. The provider will be paid the in-network rate only after being added to the ODS Plus network.
What are the names of the major vision chains that ODS contracts with?
Binyons, Oregon Eye Specialists (a.k.a., Optical Shop), Vista Optical, LensCrafters, Wal-Mart Vision Centers
If a member is a retiree or COBRA recipient who resides outside of Oregon, Washington, Idaho and Montana, he or she will use the PHCS network. When these members access this network online, they are required to indicate what logo should be on their ID card. If these members do not have an ID card when logging on, what logo should they click on?
The logo on these members’ ID card will be the PHCS logo. Members should put a check next to this logo when they review the network online.
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