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.
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inMediata
20 South Clark Street, Suite 1810
Chicago, IL 60603
(800) 417-6693
inMediata.com
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Emdeon
26 Century Boulevard, Suite 601
Nashville, TN 37214
(615) 885-3700
Emdeon.com
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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:
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.
Code
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Procedure
|
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Requested Clinical Documentation
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| D4249 |
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Crown lengthening |
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Diagnosis, current periapical or BW radiograph, and relevant clinical findings |
| D4260 |
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Osseous surgery 4 or more teeth |
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Diagnosis, periodontal charting with probings done within past 12 months, current periapical radiographs, and relevant clinical findings |
| D4261 |
|
Osseous surgery 1-3 teeth |
| D4270 |
|
Pedicle soft tissue graft |
|
Diagnosis, periodontal charting with probings done within past 12 months, and relevant clinical findings |
| D4271 |
|
Free soft tissue graft |
| D4273 |
|
Subepithelial connective tissue graft |
| D4275 |
|
Soft tissue allograft |
| D4341 |
|
Scaling and root planing 4+ teeth |
|
Diagnosis, periodontal charting with probings done within past 12 months, most recent full mouth or vertical BW radiographs, and relevant clinical findings (Please see article below for more information.) |
| D4342 |
|
Scaling and root planing 1-3 teeth |
| D7220 |
|
Surgical removal impacted tooth – soft tissue |
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Diagnosis, current periapical or panoramic radiograph, and relevant clinical findings |
| D7230 |
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Surgical removal impacted tooth – partially bony |
| D7240 |
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Surgical removal impacted tooth – complete bony |
| D7241 |
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Surgical removal impacted tooth – complete bony with unusual surgical complications |
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Diagnosis, current periapical or panoramic radiograph, and relevant clinical findings to explain the unusual complications |
*This list is not comprehensive.
Administrative forms:
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