Claims/Billing

2009 CDT Codes
Tips
Clinical Information for Consultant Review
Electronic Claims and Other Transactions
Dental Pre-Determinations
HIPAA Explanation Codes
Support for claims from other Deltas

2009 CDT Codes

Effective January 1, 2009 ODS will begin accepting the ADA CDT-9 procedure codes. We will continue to accept CDT-7 codes through March 31, 2009. Claims with any codes other than CDT-9 will be returned for correction after that date.

The ADA changes include code additions, revisions, and deletions. If you do not have a current CDT 2009 2010 manual, please contact the American Dental Association (ADA) at 1-800-621-8099 or www.ada.org to request a copy.

Offices will be able to submit filed fees for the new CDT-9 codes beginning January 1, 2009 or six months from the last filed fee update, whichever is later. Additional fee filing information is on our website under Fee Filing, or contact our Dental Professional Relations department at (503) 265-5720 or 1(888) 374-8905.

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Tips

Helpful hints to reduce claims processing time!

Submit claims electronically. ODS processes electronic claims first each day.
If submitting paper claims, please use standard ADA form typed or legibly printed.
Verify the patient's relationship to subscriber and plan information is correct before submitting claims.
Include all pertinent information: subscriber ID or recipient ID (if OHP), patient name and date of birth, tooth number (s) or quadrant, and current ADA codes.
Your office can call the ADA at 1-800-947-4746 to order the most current CDT codebook.
Please do not send x-rays unless requested by ODS. In some instances, clinical information may assist in determining benefits.
If the patient is covered by more than one ODS program, submit one claim form indicating the name of the subscriber, subscriber ID number, employer (if applicable), and ODS group number for both plans. If covered by another carrier, indicate the above information plus the name, address and policy number of the other carrier.
If a patient has primary insurance through another carrier other than ODS, the EOB of primary payment amount from the other insurance company will need to accompany the claim for consideration of payment.
ODS makes payment twice per month.
Please contact us before submitting duplicate claims:

Check Dental Benefit Tracker to see the status of a claim. If you haven't registered for this free online service, click here for more information.
If you receive a PDR indicating that your claim has already been processed before you receive a check, this indicates your re-bill was unnecessary. Claim was processed and is pending for the next scheduled payment date.
Re-billing without contacting us slows our turnaround time and delays payment.

Use miscellaneous codes appropriately with clinical information.
Code "R8" on the Payment Disbursement Register is for charges exceeding the amount allowed. This is a provider discount and should not be billed to the patient.
DO NOT USE HIGHLIGHTER ON PAPER CLAIMS.

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Clinical Information for Consultant Review

This file contains guidelines for submission on certain Dental procedures.

Clinical Information for Consultant Review

PDF File

Electronic Claims and Other Transactions

ODS is very interested in receiving claims electronically.
The advantages for your office include:
- The claim reaches ODS quickly, usually anywhere from seconds to 24 hours, depending on connection.
- Lower administrative costs for your office and ODS.
- Because electronic claims require consistent, accurate information, the incidence of returning claims to your office is reduced.
- ODS gives priority to paying electronic claims.
67% of the dental claims volume comes to ODS electronically.
50% of electronic claims are processed within 24 hours of receipt.

Below is a list of Dental Electronic Claims Providers for ODS

Clearinghouses

Emdeon (formerly WebMD)
200 West Center Street
Manchester, CT 06040
660-289-6090
Payor Number = CDOR1
APEXEDI Inc.
922 S. Main
Pleasant Grove, UT 84062
801-642-0285

EDI Health Group (EHG)
2201 Dupont Dr. #650
Irvine, CA 92614
949-852-0825

TESIA – PCI Corporation
3500 Sunrise Hwy #T-208b
Great River, NY 11739
630-922-6317

Practice Management Systems that submit directly to ODS

Dentists Management Corporation
10505 SE 17th Ave.
Milwaukie, OR 97222
503-243-3966

Quality Systems, Inc.
17882 E. 17th St. #210
Tustin, CA 92680
714-731-7171

First Pacific Corporation
4093 Commercial St. S
Salem, OR 97302
503-588-1411

Direct Connection to ODS

ODS also supports direct connections between offices and ODS if the dentist prefers this method.

Transaction standard is the 837 Dental Claim required by HIPAA Administrative Simplification.

If you have questions, please call Pat Van Dyke at 503-243-4492 or 1-800-852-5195 extension 4492.

ODS EDI Transactions Contacts

For 835-Electronic Remittance Advice/ Electronic Funds Transfer
Lan T. Pham, (503) 265-5632,
For 837- Electronic Claims
Arlene Gaddi, (503) 265-5619,
For 834-Enrollment, 270/271- Eligibility and Benefits, 276/277-Claim Status
Kathy Turner, (503) 243-4487,

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Dental Pre-Determinations

Pre-determinations are not required, but are recommended for extensive treatment.
Submit pre-determinations electronically.
The treatment form should be partially completed for pre-determination of benefits:

Check the block for "Dentist's pre-treatment estimate".
Appointment dates should not be shown.
The Dentist's signature is not required.
Please use ADA codes for all procedures.

Include any clinical information that may be helpful in determining benefits:

Often, the written description is more informative than x-rays.
Clinical information can also be useful when submitting unusual claims.

Do not submit x-rays with the pre-determination, unless requested by our Dental Consultant. Special handling is required for x-rays, which will slow the claims process.
Include complete descriptions, valid ADA codes, tooth numbers.
Use correct ID numbers: Subscriber ID number for commercial and recipient ID number for Oregon Health Plan.
Type or legibly print pre-determinations.
Watch for correct patient to subscriber relationship.

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Support for claims from other Deltas

For help with claims from other Deltas, please contact that Delta directly.

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