What’s New for Dental Providers?

The Summer 2017 issue of our Dental Bulletin includes the following topics:

• PacificSource to Gain Nearly 12,000 Dental Members This Fall
• Preventive Care Outreach and Benefit Upgrade
• The Case for Caries Risk Assessment
• Dental Claims – Tips for Avoiding Delays
• Reminder Regarding Crown Build Ups
• Network Recruiting Update – We’re Growing in Portland
• Oral Health, Overall Health

The Winter 2017 issue of our Dental Bulletin includes the following topics:

• Another Strong Year for PacificSource Dental
• With PacificSource-Legacy Partnership Finalized, Portland Recruiting Ramps Up
• Targeted Reminders Lead to More Preventive Care
• CDT 2017 Dental Code Changes
• Prescription Drug Monitoring Programs (PDMPs) Help Ensure Safe Prescribing
• 3 Tips for Successful E-claim Attachments

Read back issues.

Claims Guidelines

HIPAA Transaction Capabilities

Looking for the latest information on our HIPAA transaction capabilities? See our HIPAA Electronic Transaction Capability Status page.

Choosing a Clearinghouse

We contract with two clearinghouses listed below to provide transmission dental claims electronically; our payor ID number is 93029. 

To find out more, contact the clearinghouse directly, or get in touch with your PacificSource Provider Service Representative.

Corrected Claims Submission Guidelines

Please submit a Corrected Dental Claim Form with all corrected claims. The information you provide on this form will help us to more easily assess the reason for the change, which will result in a faster turnaround time. You should receive a form with all returned claims, or you can download it here.

If you have any questions about corrected dental claims, please feel free to contact our Dental Customer Service team at (866) 373-7053 or dental@pacificsource.com.

Practice Guidelines

Please refer to the following websites:

• ADA Clinical Recommendations
• American Academy of Pediatric Dentistry
• American Academy of Periodontology

Imaging technology

We only accept electronic attachments thru NEA Fast Attach. For more information, or to sign up, visit http://www.nea-fast.com/.  

Preauthorization

To help avoid unexpected delays, expenses, and claim denials, we recommend prior authorization for certain major, nonemergent services. Examples of services that should be submitted for prior authorization include (but are not limited to) those listed below. When requesting prior authorization, please include sufficient clinical documentation to determine eligibility and medical necessity. We appreciate your cooperation.

If you have any questions regarding prior authorizations, feel free to contact our Dental Customer Service Department at (866) 373-7053 or dental@pacificsource.com. 

We Encourage Prior Authorization for the Following Services*

All of the services below, except for D4341, D4342, and D7220, will require prior authorization beginning with dates of service on or after January 1, 2012. To request authorization for these services, you may use the ADA Dental Claim Form and mark the "Request for pre-determination/preauthorization" box.

*This list is not comprehensive.

Administrative forms:

• Corrected Dental Claim Form
• Designation of Authorized Representative
• Electronic Remittance Advice and EFT Enrollment Form (835)
• Preauthorization Request (Dental Paid Under Medical)
• Referral Authorization Request - Dental Essentials
• W-9

Questions? We're Happy to Help

Contact PacificSource Dental Customer Service for questions concerning:

• Member benefits or eligibility
• Status of a specific claim or EOP

Email: dental@pacificsource.com
Phone: 541.225.1981 (Eugene) or 866.373.7053 (all other areas)
Fax: 541.225.3655