Contracting and Credentialing
By a written contract, each dentist agrees to provide quality care to ODS members. He also agrees to prefile his fees and accept direct reimbursement from ODS.
Rules for Participating Dentists
Participating dentists agree to abide by the following rules of Oregon Dental Service, in addition to other rules established and set forth by the ODS Board of Directors:
- To submit a complete and current American Dental Association (ADA) standard dental claim form to ODS at no charge to the patient.
- To accept ODS/Delta Dental benefit payments for services provided.
- To submit a listing of usual fees to be filed with ODS for payment of dental services provided to ODS/Delta Dental covered patients. Any change in fee schedules is limited to once every six months.
It is necessary for each dentist to agree to accept fees that are at or below the 90th percentile in order to participate on the ODS panel. All fees must be accepted before participation status is granted and effective. - To keep accurate and complete financial and patient records in a manner that meets generally accepted practices.
- To allow ODS/Delta Dental access at reasonable times upon request to inspect and make copies of the books, records, and papers of a participating dentist relating to the dentist's fees charged to all his or her patients, to the services provided to patients, and to payments received by the dentist from such patients.
- To not charge an ODS/Delta Dental patient an amount in excess of the co-payment, deductible, the dentist's accepted fee or the ODS allowed amount.
- To not submit charges to ODS for payment for treatment that is not completed.
- To not submit charges to ODS for services for which no charge is made, or for which a charge increased because insurance is available (example: treatment of the dentist’s family member or employee), and have the patient statement reflect the same billed charges as the amount submitted to ODS. For example, if a discount is offered to a patient, the discount needs to be reflected in the claim submitted to ODS.
- If ODS fails to pay for covered healthcare services as set forth in the subscriber's evidence of coverage or contract, the subscriber is not liable to the provider for any amounts owed by ODS in accordance with the provision of ORS 750.095(2).
- To provide accurate and complete information to ODS.
- Notify ODS immediately of changes in service location, payment address, TIN or other W-9 information. This helps ensure that patients can find you in our directories and that checks are promptly received.
Credentialing Requirements
ODS maintains a file of your credentialing information. A copy of the Credentialing Form needs to be completed and returned to ODS as a part of your participating agreement. ODS will verify your credentials every three years. Recredentialing Form