Provider updates

Authorizations & Referrals – Tips & Tricks!

Sep 23, 2022, 15:48 PM

CareOregon Dental’s goal is to process referral and authorization requests as expediently as possible. To prevent processing and patient care delays, please use these tips when submitting requests. 

CareOregon Dental accepts referrals and authorization requests via CareOregon Connect, an online provider portal. In the three years since its implementation with dental partner clinics, the Portal has streamlined CareOregon Dental’s referral and authorization process.

With the aim of processing requests as quickly as possible, typically within a few days, we want to prevent processing and care delays by increasing efficiency. We understand your offices are busy. To facilitate the process, please keep these tips in mind when submitting referral and authorization requests:

  1. To prevent duplicate requests from being submitted, please check the Portal. The Portal can tell you if there is already a current approval for the service.

     

  2. For current (unexpired) approved referrals and authorizations where no new services are being requested, please do not submit a new Portal request. Instead, please contact the Dental Access Team. Changes that can be requested include:
    1. Specialty provider change requests (either from a PDP or the specialty provider to whom a patient was initially referred)
    2. Extension requests for current referrals or authorizations that will be expiring soon

       

  3. Before submitting a Portal referral or authorization request, please check to make sure all appropriate documentation is present:
    1. All relevant chart notes (must be completed and signed)
    2. Dental (tooth) charting
    3. Current radiographs – these must be labeled with patient’s name and dated
    4. Medical history
    5. Recent periodontal charting
    6. Treatment plan
    7. CDT code(s) that matches the requested service
    8. Patient’s current contact information – without the most current contact information, our specialty providers are unable to reach patients to schedule
    9. Care facility name and contact information (Special Needs referrals)

       

  4. Each Portal submission must contain only one specialty type. Some examples:
    1. A patient needs referrals for extractions and an immediate denture. Two separate referrals must be submitted – an oral surgery referral for the extractions and a denturist referral for the immediate denture.
    2. A patient needs a referral for a root canal and a pre-authorization for a crown. Two requests must be submitted – an endodontic referral for the root canal therapy and a general dentistry pre-authorization request for the crown.

       

  5. Timely communication is important; if the Dental Access Team reaches out for additional information, prompt responses are appreciated. Referrals and authorization processing is subject to state-mandated timelines. Responding quickly can minimize care delays and may also prevent denial of a service that might have otherwise been approved.

Portal tutorials can be found here. As always, if you have any questions, please contact the Dental Access Team – dentalaccessteam@careoregon.org.