Provider support and resources

As a CareOregon Dental provider, you may have some specific questions for us. Below, you’ll find contact and procedural information for dental providers. If you are looking for specific forms and policies, see Provider Forms and Procedures below.

Provider support and resources

Please call Provider Customer Service at 503-416-1444 or 888-440-9912. Press option 3 for provider.

Click on a topic below for more information.

Click here to download a PDF of the Provider manual.
Click here to download a PDF of the New Provider packet

CareOregon is confirming clinics’ email addresses to ensure that we can contact you with system alerts and other critical information. Please send the email address(es) that you want CareOregon to use when contacting your clinic to careoregonalerts@careoregon.org. Be sure to identify each email with a job title and name.

Send changes or updates to your clinic(s).
Email: providerupdates@careoregon.org 

CareOregon Dental has a small team of staff dedicated to working with you and your dental practice. When you call or email us, you’ll be connected with the best staff member to meet your needs. Call us at 503-488-2812 or email dentalaccessteam@careoregon.org.

For more information on Oregon Administrative Rules (OARs), Oregon Health Plan rules and what's covered and not covered under the OHP's Dental Services program, click one of these links:

Scheduling with our approved vendors

Thank you for working with interpreters to serve members who communicate in a language other than English. Our approved vendors are listed below.


Immigrant & Refugee Community Organization (IRCO)
Available for on-site, video and telephonic
Online scheduling portalirco.org/ilb Click create new appointment
Email: interpretation@ircoilb.org
Phone: On-site: 503-234-0068
For over-the-phone interpretation AND virtual (OPI and VRI): 
503-505-5187 (Available 24/7)
Translation: Email documents to translation@ircoilb.org

Linguava
Available for on-site, video and telephonic
Web: linguava.com
Online portal: portal.linguava.com
Email: scheduling@linguava.com
Phone: 503-265-8515, option 1, option 1 again
Fax: 503-954-1038

National Interpreting Service (NIS)
Specialty: American Sign Language (ASL) and other sign languages
Available for on-site and video
Online scheduling portal: nationalinterpretingservice.org.org (Please CALL 24/7 to schedule an interpreter.)
Email: schedule@nationalinterpretingservice.org
Phone: 503-932-8460
Fax: 866-411-9742

Oregon Certified Interpreter's Network (OCIN)
Available for on-site, video and telephonic
Online: oregoncertified.interpretmanager.com/
Email: carlos@oregoncertified.com
Phone: 503-213-3191, option 1
Fax: 971-228-2164

Have questions? Call Provider Customer Service at 888-440-9912, option 3. We’re here to help. 

Language resources for providers

Our goal is to help you and members get the interpreting services that meet your needs. Your facility may find these resources to be useful. 

  • “How to schedule no-cost interpreting.” This one-pager summarizes our interpreting service options and how to schedule our vendors. The backside offers tips for a successful multi-language encounter.
  • “Do you need an interpreter?" This sheet repeats the statement “I need an interpreter” in more than a dozen languages. Patients simply point to their language. Download the CPCCO version here.
  • A multilingual Language Access poster. This is another language identification tool, available in two sizes for HSO:11x17 | 12x23 (sandwich board size) and CPCCO: 11x17 | and 12x23 (sandwich board size) to display in your clinic. Patients can point to their language. It also tells them they have a right to free interpreting services, and to file a complaint if they are not satisfied. You can co-brand these with your logo.
  • Wallet-sized “I speak” cards. You can print these to give to patients, enabling them to easily request interpretation services. The cards are available in about 25 languages and include a version for those who are deaf, deaf-blind or hard of hearing.
  • Printing instructions. We give printing instructions and offer how to’s for using the materials: How to’s and printing instructions
  • Provider portal. You can also request printed materials through our Provider Portal.
  • Interpreting FAQs for providers.  Download an FAQ with details on our interpreting services and tips for a successful session

Our expectations for interpreting services

All contracted CareOregon Dental providers must make interpreting services available to CareOregon Dental members. Services must be available during and after hours for consultation and provision of care. While interpreting services can be scheduled with short notice, to ensure coverage, please schedule as soon as a member makes an appointment.

Interpreting services should be performed by certified and qualified interpreters. The interpreters may be on-staff or scheduled through a CareOregon Dental approved vendor. They may operate on-site, over the phone or via computer screen. Interpreting should not be provided by a member of the patient's family. Members should never be asked to bring their own interpreter.

Occurrences for which CareOregon Dental covers interpreting services

  • Onsite medical, dental or behavioral health appointments
  • Scheduling or rescheduling appointments
  • Appointment reminders
  • Appointment follow-ups
  • Relaying test results
  • Registration for procedures/admissions

Use only our approved vendors

CareOregon Dental pays for interpreting services so that members can access their covered health care services and benefits. We have contractual arrangements with approved vendors. Please use them when serving CareOregon Dental members. (Be sure to verify that your patient is covered by the Oregon Health Plan.) See “How to schedule no-cost interpreting.”

If providers choose to coordinate interpreting services themselves rather than through CareOregon Dental, they are responsible for paying for those services. CareOregon Dental pays only for interpreting services that providers coordinate through our approved vendors.

Provider forms

This section lists commonly used forms by CareOregon Dental providers, as well as fact sheets and other information helpful to our members. These documents are in PDF format.

Provider procedures

Click on a topic below to expand the text.

Dental referrals

CareOregon Dental members are able to see specialists only by referral from their assigned primary care dentist (PCD). Referrals should be submitted via the Provider Portal. If you need access to the Portal, or are experiencing difficulties submitting a referral, please contact the CareOregon Dental team at dentalaccessteam@careoregon.org or 502-488-2812.


Please include the appropriate documentation and pertinent information along with the referral, which includes:

  • Chart notes
  • Dental charting
  • Current radiographs
  • Medical history
  • Recent periodontal charting
  • Treatment plan

Referrals are processed within one to three business days, but can take up to two to four weeks if additional information is necessary or needs further review.


Prior authorizations

Prior authorization is not required for dental services covered under Oregon Health Plan (OHP). However, authorization may be needed for proposed treatment of non-covered dental services or when requesting to provide dental services that have restrictions and/or limitations or have not been approved via a referral.


Prior authorization requests should be submitted via the Provider Portal. If you need access to the portal, or are experiencing difficulties submitting a referral, please contact the CareOregon Dental team at dentalaccessteam@careoregon.org or 502-488-2812.  Please include appropriate documentation and pertinent information along with the prior authorization request from the list above.

CareOregon Dental is always secondary to any primary insurance. To ensure proper coordination of benefits, please notify CareOregon Dental with a courtesy call if the member has primary dental insurance.

State and federal regulations prohibit billing Oregon Health Plan recipients for OHP-covered services, except for coinsurance, copayments and deductibles expressly authorized by the General Rules, OHP Rules and/or federal rules.


Members cannot be billed for the following covered services:

  • Services that were denied due to lack of an authorization.
  • Services that were denied because the member was assigned to a PCP other than the one who rendered the services.
  • “Balance billing” for the amount not paid to the provider by CareOregon.

Generally, a provider may legally bill an Oregon Health Plan recipient in the following three circumstances (refer to above OAR for other examples):

  • The service provided is not covered by OHP and the member signed a Patient Responsibility for Uncovered Services form before they were seen.
  • The member did not tell the provider that they had Medicaid insurance and the provider tried to obtain insurance information.
  • Signed DMAP Form 3165.

Becoming a CareOregon Dental provider 

CareOregon Dental provides dental plan services to two coordinated care organizations supporting and enhancing sensible, localized, coordinated care.

If you are interested in becoming a contracted provider please review our Credentialing Requirements for primary dental care providers and dental specialists.

If you have additional questions or would like to inquire about the contracting process, please contact the CareOregon Dental team at 503-488-2812 or by email at dentalaccessteam@careoregon.org. Thank you for your interest in joining CareOregon Dental’s provider panel!

In your email, please include the following information:

  • Provider name or clinic name
  • Specialty
  • Phone number
  • Email address
  • Fax number
  • Physical address
  • NPI
  • TIN
  • DMAP ID #

 

Clinical Practice Guidelines

CareOregon Dental is dedicated to supporting our providers with evidence-based clinical guidelines to help achieve the best health outcomes for our members. The CareOregon Dental Quality Subcommittee (DQS) meets regularly to ensure quality standards of care are being met by our providers and to review clinical guidelines for dissemination.


Click on a topic below to expand the text.

The CareOregon DQS adopts evidence-based guidelines. Once adopted, they are placed on this webpage (below). Paper copies are available on request. For more information on the guideline selection and adoption process, our Clinical Guidelines Policy & Procedure document is available on request.

For CareOregon’s medical-approved guidelines, visit the CareOregon website.

Opioid Educational Resources

The Dental provider pain management recommendations materials highlight how dentists can positively impact the opioid epidemic and includes an easy to follow dosage guide. CareOregon Dental has released these opioid materials in collaboration with all the Oregon Health Plan dental care organizations. For complimentary printing and delivery, please contact oralhealth@careoregon.org with any inquiries or requests.

CareOregon Dental, in collaboration with other Medicaid dental plans, created educational patient materials as part of a statewide effort to reduce opioid prescribing. Materials address why an opioid was or was not prescribed and includes messaging on safe use and disposal. Each version is printed in both English and Spanish. For complimentary printing and delivery, please contact oralhealth@careoregon.org with any inquiries or requests.

To view each material click and option below: 
How to use your prescription safely
Manage pain without opiods

CMS fraud, waste and abuse training

  • Training documents can be found here.
  • CareOregon takes fraud, waste and abuse seriously. If you suspect that benefits aren't being used correctly or want to report a case of fraud, waste or abuse, please contact Ethics Point at 888-331-6524. You also can file a report online at ethicspoint.com.

How to submit claims

Please use the standard American Dental Association (ADA) claim form (2006 or newer).


To submit claims electronically, use EDI Payer ID 93975. For more information on electronic claims, contact Change Healthcare toll-free at 877-363-3666 or visit their website at changehealthcare.com.


Mail paper claims to:
CareOregon Claims
PO Box 40328
Portland, OR 97240


For claim inquiries, you have several options:

  • Send your claims inquiries by email to claimshelp@careoregon.orgNote: All emails containing protected health information (PHI) must be sent securely. We are unable to respond to emails that are not sent securely.
  • Call 503-416-1444 or 888-440-9912. Press option 3 for provider.
  • Fill out the Provider Claim Appeal form.

Other provider community resources

Free transportation for your patients

Transportation to physical, dental and mental health care appointments is a free benefit to OHP members. You can help your patients get care by helping get them there! Members can get transit passes, be provided rides or get help paying for gas at no cost.


In Multnomah, Clackamas and Washington counties, contact Ride to Care at 503-416-3955 or 855-321-4899 or visit ridetocare.com.


In Tillamook County, contact NW Rides at 888-793-0439 or visit nworegontransit.org/nw-rides.


What do I need to tell Ride to Care/NW Rides when scheduling a ride for my patient?

  • Your patient's Oregon Health Plan number
  • The date and time of the appointment
  • The name, address and phone number of your patient's destination(s)

 

OneHealthPort 

OneHealthPort provides free, secure access to participating Oregon Health Plan and other payor administrative websites through a single login process. Click here for more information about OneHealthPort Oregon.