What’s New for Dental Providers?

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

 

Affiliated Network Services

20 South Clark Street, Suite 1810
Chicago, IL 60603
(800) 417-6693
ANSdirect.com  

 

Emdeon

26 Century Boulevard, Suite 601
Nashville, TN 37214
(615) 885-3700 
Emdeon.com

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

 
 

Procedure

 
 

Requested Clinical Documentation

 
D4249   Crown lengthening   Diagnosis, current periapical or BW radiograph, and relevant clinical findings
D4260   Osseous surgery 4 or more teeth   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   Diagnosis, current periapical or panoramic radiograph, and relevant clinical findings
D7230   Surgical removal impacted tooth – partially bony
D7240   Surgical removal impacted tooth – complete bony
D7241   Surgical removal impacted tooth – complete bony with unusual surgical complications   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

InTouch for Providers

Access your PacificSource account information 24/7.

Medicaid Dental Providers

Learn more about our contracted dental provider networks for Medicaid dental services.

Learn more >

Join Advantage Dental Today

Advantage Dental is the exclusive network for PacificSource Health Plans, and we’re growing throughout the Northwest. As a participating provider, you’ll not only increase your patient volume, but also enjoy discounts on dental supplies you use every day. The contracting process is easy, and there are no fees to participate! 

To get started, go to Secure.AdvantageDental.com/Credentialing.

Last updated 3/14/2017