Dental BulletinPacificSource logo

Summer 2018

In this issue:

Dentists’ Role in Preventing Opioid Misuse >

PacificSource Dental Growth and Performance >

Network Recruiting Update: Portland Expansion Continues >

Educating Insurance Brokers on the Mouth-Body Connection >

Preview of 2019 CDT Dental Code Changes >  

Fluoride Varnish Benefit Reminder >

3 Documentation Tips for Crown Claims >

Questions? We’re Happy to Help >


Dentists’ Role in Preventing Opioid Misuse

Opioid use disorder and deaths from opioid abuse have reached epidemic proportions in the United States. According to the U.S. Department of Health and Human Services, 2.1 million Americans were reported to have an opioid use disorder in 2016. In addition, 11.5 million people misused prescription opioids during 2016, and more than 42,000 died from overdosing on opioids.

Dentists are major contributors to the overall number of opioids prescribed and to the number that are available for misuse or abuse. Studies have shown that dentists are among the most common prescribers of opioids and they rank first for prescribing to adolescents and young adults.1 Dentists write approximately 31% of opioid prescriptions for patients aged 10-19 years.2 This is especially concerning, because patients who are first introduced to opioids as teenagers are up to 33% more likely than those who have not received an opioid to misuse opioids as young adults.3

To assist dentists in appropriate prescribing of opioid paid medication for their patients, the Oregon Health Authority (OHA) has developed Opioid Prescribing Guidelines for Dentists (a one-page PDF). These guidelines can be found on the OHA Public Health website at:

1. Volkow ND, McLellan TA, Cotto JH, Karithanom M, Weiss SR. Characteristics of opioid prescriptions in 2009. JAMA 2011;305:1299-301.

2. Denisco RC, Kenna GA, O’Neil MG, Kulich RJ, Moore PA, Kane WT, Mehta NR, Hersh EV, Katz NP. Prevention of prescription opioid abuse: The role of the dentist. The Journal of the American Dental Association 2011;142:800‐10. 

3. Miech R, Johnston L, O’Malley PM, Keyes KM, Heard K. Prescription opioids in adolescence and future opioid misuse.; Pediatrics. 2015 Nov;136(5):e1169-77.  


PacificSource Dental Growth and Performance

The first half of 2018 closed out strong for PacificSource Dental with continued growth, retention, and on-target claims and customer service measures. The commercial dental product has grown by more than 8,000 new members in 2018, a 13% growth over last year. We’ve added 12 new large groups, with all but one being well over 100 employees. Our total dental membership, including government lines, is now over 131,000 members. For the last 12 months, we have retained over 81 percent of dental groups, including 89 percent of our large group business.

Year-to-date, our claims turnaround time averaged 9.85 days, while our average speed to answer dental calls was 25 seconds.

We are off to a great start in 2018 and look forward to another record year of results!


Network Recruiting Update: Portland Expansion Continues

Our strong partnership with Legacy Health and close collaboration with Advantage Dental have enhanced our recruiting efforts in the Portland market. Recruiting efforts from mid-2017 to mid-2018 have resulted in an increase of well over 100 providers to the tri-county area.

Advantage Dental and PacificSource will aggressively recruit providers in the Portland area throughout 2018 and beyond. Our hope is that the PacificSource network can become large enough in this region to continue to attract groups of all sizes and individuals to the quality health and dental products we offer.

We are excited about this growth and hope you are as well—with a strong network comes more patients!  


Educating Insurance Brokers on the Mouth-Body Connection

Dr. Jim Gimarelli, Dental Director for PacificSource, has been conducting continuing education presentations to our brokers across Oregon over the past several months. The course, called The Mouth-Body Connection, covers the importance of dental insurance and the positive impact regular dental cleanings have on overall, systemic health. Dr. Gimarelli has presented to over 250 brokers statewide. It’s important that our brokers understand the importance of dental insurance and the positive impact on systemic health as they market medical and dental product to their customers.


Preview of 2019 CDT Dental Code Changes

The National Association of Dental Plans has advised PacificSource that there will be fifteen new CDT codes added for 2019. Four current CDT codes will be deleted. Determinations on coverage for new 2019 CDT codes will be published in the Winter edition of the Dental Bulletin, scheduled to go out in December. 


Fluoride Varnish Benefit Reminder

As a reminder, our standard benefit for fluoride varnish, as of January 1, 2018, for small groups, individual dental plans, and large group standard plans, is four times per year within the plan or calendar year for all patients at high risk for dental caries. For our large custom groups, this change is optional; please contact us if you have any questions.


3 Documentation Tips for Crown Claims

In our last issue, we outlined our documentation requirements and clinical standards for crowns. Here are a few more tips and reminders for ensuring your crown claims are not delayed:

  • We cannot accept faxed X-rays due to low quality.
  • Please do not send original X-rays to us.
  • Electronic attachments are accepted with NEA only. 

Thank you for your cooperation! 


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


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

Fax: (541) 225-3655

Contact Advantage Provider Relations for questions concerning:

  • Becoming a contracted provider
  • Provider contracts


Phone: (866) 268-9616


Fax: (866) 268-9318



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