I NEED IT COVERED!
Cleanings are covered only for people under 18? True or False?
False, Cleanings are covered for all OHP patients.
What does OHP stand for?
Oregon Health Plan
What is the term used for a denial for an OHP patient?
A. NCAA
B. NAACP
C. NOABD
D. ABD
C. NOABD
Prosthetics eaten by small dogs are automatically covered. True or False?
False, only covered if eaten by a dog over 100 pounds.
False, the patient should schedule an appointment with a provider to go over treatment options.
What does DCO stand for?
Dental Care Organization
EVERYONE
Columbia Pacific
Partial dentures can be replaced every 7 years if dentally necessary. True or False?
False, Partials can be replaced every 5 years if dentally necessary.
What does CCO stand for?
Coordinated Care Organization
What is completed by the office whenever a patient pays for a service not covered by OHP?
OHP Waiver
If a patient with Apple Care offers you $100, can you make an exception to have them assigned to Willamette Dental?
Only if they make it $200.
No, we do not accept Apple Care.
What is the frequency limitation for complete dentures?
Complete dentures can be replaced every 10 years if dentally necessary.
What does IHN stand for?
interCommunity Health Network
Denial (NOABD) letters are written on CCO letterheads. True or False?
True
Name one portal website that allows Reps to find a patients' Member ID number?
MMIS
PH Tech
Onehealthport
Who would have coverage for Orthodontia under OHP?
Covered only for clients under 21 years old, with medical diagnosis of craniofacial anomalies resulting in significant malocclusion (i.e. cleft palate or cleft
palate with cleft lip) or with handicapping malocclusion that requires orthodontia. Pre-approval required with documentation.
What does OHP "Open Card" mean?
The patient has active OHP coverage and has not been assigned to a Dental Care Organization.
If a patient is notified a service is not covered but does not want to move forward with the service at this time, is an NOABD necessary?
Yes, anytime an active OHP patient is notified by a provider a service is not covered, they should be sent a denial letter. The only exception would be if the patient moves forward with an alternative covered service.
A patient does not have an Accountable Care Plan and has OHP not currently assigned but is having a dental emergency. Should we schedule the patient?
No, we should not schedule the patient if the patient is not showing assignment to Willamette Dental.