You can use Dental Benefit Tracker. It provides comprehensive information about your patient’s Medicaid benefits. To see the next available date for preventive services, check the preventive services box. You can also see additional benefit information on the improved Group Limitations page. And, you will find a link to the list of covered and non-covered services. Please call ODS Community Dental customer service at 800-342-0526 for help verifying eligibility and benefits.
Some ODS Community Dental members are assigned to a specific dental office for comprehensive dental care. When accessing the Group Limitations section of Benefit Tracker, it’s important to look for messaging regarding member assignment. Services performed for a capitated member by a non-capitated provider are not covered, unless there is a referral on file.
You may send a letter and supporting chart notes to ODS Dental Correspondence at 601 S.W. Second Ave., Portland, OR 97204. If we are still unable to cover the service, we will issue the member a notice of action denial letter with hearing and appeal rights.
This method allows us to have open conversations with your office to ensure that members receive the best care options.
When you refer your patient to a specialist, please notify us by email at firstname.lastname@example.org with the following information:
The member’s primary care dentist will refer their patient to your office directly. You must confirm the member’s eligibility on the date of their appointment. It is also important to check the Group Limitations section of Benefit Tracker to see if the member is assigned to a dental office. If the member is assigned to a dental office, contact the referring provider or ODS Community Dental customer service to confirm a referral has been submitted. Services performed for a capitated member by a non-capitated provider are not covered, unless there is a referral on file.
Contact ODS Community Dental case management at 844-274-9124 for assistance with special needs referrals. We offer dental case management to all members with special healthcare needs. We also engage with the members, caregivers and primary care dentists to ensure members receive treatment, and to coordinate and meet access needs.