Resources to help you serve our members

Provider onboarding
Fraud Waste and Abuse Provider Training

Everything you need to know about working with ODS Community Dental is in your provider handbook. Please take a look.

Provider handbook

Please make sure you use the patient responsibility waiver form provided by the Oregon Health Authority as your client agreement to pay for health services. Get the patient responsibility waiver:

Patient responsibility waiver in English
Patient responsibility waiver in Spanish
Patient responsibility waiver in Russian
Patient responsibility waiver in Vietnamese
Patient responsibility waiver in Somali
Patient responsibility waiver in Korean
Patient responsibility waiver in Traditional Chinese
Patient responsibility waiver in Arabic
Patient responsibility waiver in Simplified Chinese

You can use our Health through Oral Wellness® program to clinically assess the oral health of your patients and offer extra benefits to those who are at greater risk for oral diseases. The ODS Health through Oral Wellness flyer provides additional information about the program including the benefit grid.

Health through Oral Wellness may also be a benefit for your Delta of Oregon patients. To learn more about the program, visit deltadentalor.com/oralwellness/providers/ or call dental provider services toll-free at 844-663-4433.

Below, you will find forms you may need to help you serve our members. If you need a form that is not listed below, please call us: 800-342-0526.

• Associate Add Term Request
• Clinic DMAP Enrollment Form (Proof of Ownership)
• Covered and non-covered dental services
• Credentialing
• DMAP provider enrollment
• ERA EFT enrollment
• Health through Oral Wellness^® flyer & benefit grid
• HLD Index Scoresheet
• Interpreter request form
• Missed appointment and dismissal notification form
• Notice of address change
• Notice of sale of practice
• NPI fact sheet
• ODS GA Approval Request form provider letter
  
• ODS General Anesthesia Approval Request Form
• ODS Benefit Review: Provider Process NEW!
• ODS Dental Provider Correspondence Request Form
• OHP referral form
• OHSU Specialty Clinics NEW!
• OHSU Dental Clinics Referral Form NEW!
• Provider refund submission
• Quit Line materials for your office
• Quit Line fax referral in English
• Quit Line fax referral in Spanish
• Recredentialing

Provider diversity data - submit diversity, equity, and inclusion focused information for yourself (contracted practitioners)

Clinic diversity data - submit diversity, equity, and inclusion focused information for contracted clinics/facilities

• Access Monitoring
• Appointment Scheduling
• Care for Members with Special Needs
• Clinical Guidelines
• Communication Accessibility
• Cultural Responsiveness Training
• Dental Case Management
• Inter Rater Guidelines
• OHP Timely Access to Care Training
• Providers
• Transition of Care

Need more info? Take a look at our FAQs.

Frequently asked questions

Arrow Dental Clinic assignment FAQs - Hermiston
Arrow Dental Clinic assignment FAQs - Milwaukie