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Member Provider

Resources to help you serve our members

Information for new providers

Your provider handbook

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

Provider handbook

Patient responsibility waiver

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 Russian
Patient responsibility waiver in Spanish
Patient responsibility waiver in Vietnamese

Improve your patients' oral health and your bottom line

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.

To learn more about the program, visit deltadentalor.com/oralwellness/providers/ or call dental provider services toll-free at 844-663-4433.

Get the form you need

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.

Covered and non-covered dental services
DMAP provider enrollment
ERA EFT enrollment
Health through Oral Wellness®
Interpreter request form
Missed appointment form
Notice of address change
Notice of sale of practice
NPI fact sheet
ODS General Anesthesia Approval Request Form
OHP referral form
Provider directory
Provider refund submission
Quit Line fact sheet for clinic offices
Quit Line fax referral in English
Quit Line fax referral in Spanish

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

Frequently asked questions

Need more info? Take a look at our FAQs.

Frequently asked questions