Customer Service
What is the Dental preferred scripting when opening a call?
Dental Customer Service this is ___ may I have the Subscriber ID?
What is the claims address?
PO Box 40384
Portland OR 97240
What does the complete series (FMX) share a frequency with?
Panoramic Radiographic image (D0330)
This plan change can only be done 1 x 12 months.
What is DCO Reassignment
Where can we find the ODS provider fees? Can those fees be provided to members?
It can be found on the OHP Covered/Non-Covered Services page in BT. No, we do not share this information with the members.
What P&P would we access for System Issue Scripting?
CSR118
What is RMI Letter 4b, and can we accept that information over the phone?
RMI Letter 4b is sent when a quadrant is missing. Yes, we can accept that information over the phone.
Name the 4 ways that a provider can request an interpreter?
Call, Fax, Email and place the order online with Passport to Languages.
What is Capitation?
A payment arrangement for healthcare service providers, such as dentists, that will pay the provider a set amount for each enrolled person assigned to them, per period of time, whether or not that person seeks care.
If a member calls in and wants a copy of the EOB can we provide them a copy?
No, they are only for the providers. OHP members do not receive EOBs.
What CCO/group is allowed to request demographic changes?
EOCCO 10009552
Name the 5 reasons why would segment a claim.
Multiple payees involving different providers
Dates of service cross plan/benefit year
Dates of service cross Provider’s network status
Predetermination billed with dates of service
Predetermination claim billed with “different treatment plans”
What is the oral health assessment program that is used for Health Through Oral Wellness?
Previser
What is the difference between a Provider Reassignment and a DCO Reassignment?
Provider reassignment refers to the process of changing your assigned clinic or becoming unassigned in order to see your preferred OHP provider. DCO reassignments involve switching to or from a different Dental Care Organization, allowing you to choose your preferred OHP provider.
Using the TIN 711015456 for Soft Touch Dentistry of Portland are there any current payment reductions?
Yes, for $179.
Who does the member contact for a CCC letter?
Client Services Unit (CSU) 1-800-273-0557
Using claim ID 251294130400, why was $98.00 disallowed?
Denied due to frequency
81B: Limited to Once in a Six Month Period.
DP2: The Maximum Allowed has been Reached
What is our standard frequency for SRP?
Benefit is limited to once per quadrant every 2 years. Maximum of 2 quadrants on one date of service is payable except in extraordinary circumstances.
What are the reasons we will accept a mid-month plan change request?
Customer identifies the member as a foster child, the customer is from DHS, a foster parent, a resource parent, or indicates they need to schedule an assessment
Member has recent claim history on file with that pediatric dentist, general dentist, or Oregon Mobile Hygiene
Member has a scheduled appointment with a general dentist or pediatric dentist
Member is unable to schedule with a general dentist or pediatric dentist, or Oregon Mobile Hygiene until unassigned
Where can we find the ODS provider fees? Can those fees be provided to members?
It can be found on the OHP Covered/Non-Covered Services page in BT. No, we do not share this information with the members.
What information can be provided to a subscriber for a covered adult dependent without verbal approval or valid AuthPHI?
May answer claim payment questions (the financial detail of EOB). No other PHI without verbal approval or valid AuthPHI.
Daily Double
Denied due to frequency – 1x5yrs
History is on file for 01/13/2021
Using the ID# CR201B1G, Montgomery Pepper DOB 11/14/2007. What is this member's CCO and DCO?
Per MMIS member is active with
CCO- Jackson Care Connect (855)722-8208
DCO- Capitol
Daily Double
Yes, it can be done since she is with EOCCO.
Claim 251392567600 was processed and paid incorrectly and needs to be sent back for adjustment. Using Inquiry Web and Content Manager, what error do you identify on the claim?
Per DRN 2025139E047806828, the treating provider is Mitchelle Westberg.