PacificSource Dental Bulletin

In this issue: 

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 >


PacificSource to Gain Nearly 12,000 Dental Members This Fall

We’re pleased to share that PacificSource has secured five large medical and dental groups: Willamette University, Umatilla County, Belgrade Schools, Deschutes County, and Billings Clinic. These groups, which amount to almost 12,000 new dental members, will come onboard between July 1, 2017 and January 1, 2018.

This significant growth reflects our strategy of focusing on our core dental product strengths: prevention, the Advantage Network, a diverse product portfolio, products for the entire family, and superior claims and customer service capabilities.

Preventive Care Outreach and Benefit Upgrade

In July, we sent postcards and emails to our PacificSource dental members who did not visit the dentist in 2016, reminding them to make a dental appointment. We did this in 2016 as well and saw an increase in the number of members who scheduled a dental appointment. We hope for similar success in 2017.

As research has shown, members who get regular dental checkups and cleanings have better dental health. Better oral health is also linked to better overall systemic health, with less incidence of heart disease, diabetes, strokes, premature births, arthritis, breast cancer, and more.

In addition to this campaign, one of the benefit changes for all our standard 2018 dental plans will be the removal of the age limitation for fluoride varnish effective January 1, 2018. This change is in alignment with our commitment to encouraging preventive care.

The Case for Caries Risk Assessment

The American Dental Association Code on Dental Procedures and Nomenclature (CDT Code) introduced codes for caries risk assessment beginning in January of 2014 (D0601, D0602, and D0603). Caries risk assessment is a reliable screening method for caries prediction and for appropriate treatment planning based on risk. Dental caries is a continuum of disease that begins with subclinical changes at the molecular level that can be effectively managed with chemotherapeutic and behavioral approaches. Waiting to treat dental caries until a cavitated lesion (“cavity”) is clinically evident is too late and no longer the standard of care.

Studies have shown that incorporation of caries detection, classification, risk assessment, and prevention strategies is effective in reducing patient’s risk of dental caries progressions and may even arrest or reverse the disease process.

Resources for caries risk assessment and management:

Dental Claims – Tips for Avoiding Delays

PacificSource makes every effort to pay dental claims within 30 days of receipt. However, we can only achieve that goal when the information we receive is timely, accurate, and thorough.

Be Timely

  • File claims with PacificSource within 90 days of the date of service.
  • If not submitted in 90 days, please send an explanation as to why it was not submitted
  • We do not pay claims submitted more than one year after the date of service.

Be Thorough

  • If we need additional information to process a claim, we will send a letter within 30 days stating the claim is delayed.
  • If we have requested additional information, you’ll have 15 days to send it. If not received, we will deny the claim; however, you may still send the information and the claim will be reconsidered.

Be Careful
Here are the top issues that slow or hold up claims:

  • Adding a preauthorization number to your claim. This stops your claim.
  • Not sending documentation correctly or not sending requested documentation.
  • Not sending primary explanation of payment (EOP) if PacificSource is the secondary insurance.

Questions about a claim? We’re happy to help. Please see contact information at the end of this email.

Reminder Regarding Crown Build Ups

Please be aware that PacificSource limits crown build ups (D2950) by contract to endodontically treated teeth. When submitting claims for D2950, including a PA or BW radiograph to show previously completed endodontic treatment will assist in timely processing of the claim.

Network Recruiting Update – We’re Growing in Portland

With our recent partnership with Legacy Health Plans (in 2016), we are working closely with Advantage Dental to enhance our recruiting efforts in the Portland market. A recruiting blitz in this region during the first quarter of 2017 has yielded meaningful network growth in this targeted area – over 60 newly contracted dental providers in Portland.

Because of the desire to bring the 22,000-plus Legacy employees over to a PacificSource dental plan, we will continue to aggressively recruit providers in the Portland area throughout 2017 and 2018. 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!

Oral Health, Overall Health

By R. Mike Shirtcliff, DMD
President, Advantage Dental

You have likely read or heard that if you have a healthy mouth you have a tendency towards better overall health. In fact, the Academy of General Dentistry estimates patients with good oral health save $2.50 per month in out-of-pocket healthcare expenses.

Most PacificSource dental plans cover 100 percent of class one in-network services, such as exams, tests, radiographs, cleanings, and fluoride treatments. Yet not all covered patients see their dentist for these class one services. 

The ADA and the ODA have recently been discussing how dentistry can help with the overall health of people and how they should be paid for this. I would suggest that dentists wear two hats in that they are doctors, trained in medicine nearly as much as physicians are. Dentists can take health histories, blood pressure, and make referrals. 

Since people with healthy mouths generally have better health outcomes, and most dental plans cover class one services at 100 percent, then my questions are:

  • Why don’t more people with insurance coverage receive their class one services? 
  • How do we – dentists and payors – change this? 
  • How can the healthcare system reallocate payments to encourage change and achieve the best health outcomes? 
  • How do we incentivize the physician to perform oral health screenings and risk assessments? 

The goal is to increase preventive care – for those at high risk to get to the dentist so they can avoid losing their teeth or having expensive restorative surgical procedures. Better preventive care will also reduce the use of antibiotics and opioid medications, avoidable hospitalizations, and emergency department visits.

This is all food for thought in this changing healthcare world, in which we strive for a better patient experience, with better outcomes, at a better cost! 


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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