Dental BulletinPacificSource logo

Fall 2019

In this issue:

Where has the time gone?

2020 CDT Code Changes

Meet Janet Westphal, Manager of Network Development

Oregon Passes Bill Allowing Dentists to Administer Vaccines

Using the Corrected Dental Claim Form  

Choose Your Arch: CDT 2019 Dental Code Changes

Want To Avoid Claim Processing Delays?

Questions? We’re Happy to Help


 Where has the time gone?

By Jim Gimarelli, D.M.D., Dental Director for PacificSource

It was ten years ago, in July 2009, that PacificSource and Advantage Dental signed a contract involving nearly 30,000 commercial dental members, making Advantage our dental PPO in Oregon and Idaho. 

What a rewarding partnership it has been. Central to the relationship is the mutual trust and respect shown by both parties, along with a shared commitment to improving the dental health of our communities. I want to personally thank Dr. Mike Shirtcliff, Ellie Naderi, Dr. Gary Allen, Kevin Boie, Michelle Lauerman, and Missy Mitchell—all of whom I’ve had the pleasure to work closely with, and who’ve been great mentors, peers, and friends.

I also want to thank the hundreds of Advantage dentists who are responsible for the dental care of so many. We at PacificSource appreciate your dedication and commitment.

  

Looking back from our 2019 vantage point, it’s easy to see the progress we’ve made since 2009. We’ve grown to nearly 74,000 commercial dental members, and to almost 138,000 commercial and government members overall. 

Two more key metrics: Dental case retention has grown from 73% to more than 85%. And the number of dedicated dental claims and customer service reps has more than doubled—helping us continue delivering the kind of world-class service our members and providers deserve. 

Our dental product has become a core competency for PacificSource over the past five years, and we’ve seen our medical lines grow because of it. As evidence, I cite the recent addition of PacificSource medical coverage to eight large groups that had previously been dental only.

  

I’m pleased to report on PacificSource’s continued efforts at improving the dental health of our communities, specifically the practice of reaching out to members, by email or postcard, who’ve not seen a dentist in the previous twelve months. It isn’t just their dental health that’s affected. We know that as members get regular cleanings, overall health improves—particularly in the areas of heart disease, diabetes, stroke, premature birth, and arthritis. 

In closing, let me express my gratitude to Advantage Dental for being such terrific partners. Thanks for all we’ve accomplished together these last ten years. 

 


 2020 CDT Code Changes

CDT code additions, deletions, and changes were determined for 2020 during the March 15, 2019 meeting of the Code Maintenance Committee. Thirty-seven new CDT codes will be added and six current codes will be deleted. Fifteen of the new codes are implant codes and eight are orthodontic codes.

Among the new codes will be a nonclinical administrative code for Dental Case Management of Patients with Special Health Care Needs—to facilitate documentation of services for this high-needs population.

Determinations on PacificSource coverage for the new 2020 CDT codes will be published in the winter edition of the Dental Bulletin. The new codes will be effective January 1, 2020 through December 31, 2020. 

 


 Meet Janet Westphal, Manager of Network Development

Janet Westphal is the new Manager of Network Development for Advantage Dental From DentaQuest. She is responsible for recruitment and retention of the PacificSource-Dental Advantage commercial network throughout Oregon and Idaho.

Janet looks forward to strengthening her relationships with providers and their staffs, and to building a dynamic dental network for PacificSource and its members. She can be reached at jwestphal@advantagedental.com.

 


 Oregon Passes Bill Allowing Dentists to Administer Vaccines

When House Bill 2220 was signed by Governor Kate Brown on May 6, Oregon became the first state in the nation to allow dentists to administer vaccines to patients. The bill will require dentists providing vaccinations to take an additional continuing education training course and meet state-mandated vaccine storage and reporting requirements.

The Oregon Board of Dentistry is in the process of developing rules to implement the new law, and expects rules to be finalized by January 1, 2020.

 


 Using the Corrected Dental Claim Form

In reviewing your claims, PacificSource may occasionally request additional information and/or x-rays. In these cases, please use the corrected dental claim form available on our website. If you’re asked for additional information, you don’t need to submit a new claim—just complete the corrected claim forms and send it to us. 

If you’re making a change to the CDT code, please include chart notes to support the change. You’ll find corrected claim form at PacificSource.com/provider/forms-and-materials.

 


 Choose Your Arch: CDT 2019 Dental Code Changes

We’ve seen some cases where claims with certain codes weren’t paid because needed information was missing. Going forward, providers will need to specify an arch on these claims in order for them to be processed.

The affected codes: 

  • D9944: Occlusal guard – Hard appliance, full arch
  • D9945: Occlusal guard – Soft appliance, full arch
  • D9946: Occlusal guard – Hard appliance, partial arch

 


 Want To Avoid Claim Processing Delays?

We get it: You want your claims processed as quickly as possible. One way to head off potential delays is by including chart notes and x-rays along with your claim submissions.

As an example, when we receive a claim for root planing and scaling, our team will require periodontal charting as well as x-rays in order to process the claim.

Supporting documents can be submitted in the following ways:

Thanks for taking the time to be sure our claims processing team has the info they need. We appreciate it.

 


 Questions? 
We’re Happy to Help

Contact PacificSource Dental Customer Service for questions about:

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

Email: dental@pacificsource.com

Phone: Eugene: (541) 225-1981. All other areas: (866) 373-7053

Fax: (541) 225-3655

Contact Advantage Provider Relations for questions about:

  • Becoming a contracted provider
  • Provider contracts
  • Advantage fee schedules

Email: providerrelations@advantagedental.com

Phone: (866) 268-9616

Website: www.AdvantageDental.com

Fax: (866) 268-9318

PRV3_0919

 

PacificSource logo                                       DentaQuest AdvantageDental logo