Coordinated Care Organization – a holistic approach to healthcare

PORTLAND, OR (December 6, 2013) – As part of the healthcare transformation, Oregon has moved to a Coordinated Care Organization (CCO) model. This holistic approach to healthcare combines medical, dental and mental health with a focus on improving quality while managing costs.

Today, there are 15 CCOs throughout Oregon that cover over 90 percent of Medicaid participants. As of July 1, 2014 we are partnered with a number of CCO organizations servicing the following counties.

• AllCare – Curry, Douglas, Jackson and Josephine counties
• InterCommunity Health Network – Benton, Lincoln and Linn counties
• Primary Health of Josephine County – Douglas, Jackson and Josephine counties
• Willamette Valley Community Health – Benton, Clackamas, Linn, Marion, Polk and Yamhill counties
• FamilyCare, Inc. – Clackamas, Marion, Multnomah and Washington counties
• Health Share of Oregon – Clackamas, Multnomah and Washington counties
• Jackson Care Connect – Jackson County
• Columbia Pacific – Columbia, Clatsop and Tillamook counties
• Trillium Community Health Plan – Benton, Lane and Linn counties
• Eastern Oregon Coordinated Care Organization (EOCCO) – Baker, Gilliam, Grant, Harney, Lake, Malheur, Morrow, Sherman, Umatilla, Union, Wallowa and Wheeler counties
• PacificSoure Community Solutions – Crook, Deschutes, Hood River, Jefferson, Klamath and Wasco counties
• Yamhill County Care Organization – Clackamas, Marion, Washington and Yamhill counties

What does this mean for you and your patients?

Your current Medicaid patients that are part of the CCOs listed above will be notified of this change. They will continue to be assigned to ODS so they can still see you for their care. New Medicaid patients can request the ODS DCO to see ODS dentists if they aren’t assigned to our DCO.

On a day-to-day operational level, your process is unchanged. You will continue to send claims to ODS and be paid your OHP rate. Member information will continue to be available through Benefit Tracker. In the case of Willamette Valley Community Health, Primary Health of Josephine County and AllCare, the ID card will be produced by them instead of ODS. The ID card may look different than what you’ve seen in the past, and will indicate ODS Community Health.

Medicaid Expansion

Another change coming soon is the elimination of the ODS Standard plan. Beginning January 1, 2014, Medicaid members will automatically move to the improved benefits of the Plus plan due to Medicaid expansion.

You may have patients in your practice that now have Medicaid and wish to continue receiving their dental care from you. If you are already an OHP/Medicaid participating dentist with ODS, then you are all set.

If you do not currently participate with ODS as an OHP/Medicaid provider and want to retain these newly eligible Medicaid patients in your practice, please contact Dental Professional Relations at 503-265-5720 or 888-374-8905. They’ll help you with the necessary documentation to get started.

Verifying Medicaid Member eligibility

Because we know how valuable your time is at the office, we want to help you cut down on the number of Medicaid member eligibility calls you’re making to our customer service department. This can be time-consuming for you and keep you away from other important tasks!

With the Medicaid model changing to Coordinated Care Organizations (CCOs) we know that you may have many Medicaid member eligibility inquiries to confirm to get ready for the next day. We’d like to remind you that we do offer an email and Fax back option for verifying Medicaid member eligibility, and Benefit Tracker is also available for your use and our recommended method for time-savings.

By utilizing these electronic methods for checking eligibility, our goal is to help you decrease the number of Medicaid member eligibility phone calls each day.

Simply email ODS OHP Customer Service at ohpdental@odscompanies.com. You will need to identify yourself, your patient, and your request as explained below.

Provide your identification:

• First name of caller
• Provider’s last name, or clinic/Provider office name
• Provider TIN

Provide member identification:

• Member recipient ID number*
• Member last name and first name
• Member date of birth

*If the recipient ID is not known, please be prepared to provide the Member Social Security Number (SSN) and member address

Our goal is to send a response within 24 hours Monday through Friday, excluding holidays.

You may also fax your request to 503-765-3297. Just fax us the list of ODS OHP members’ including the member’s first and last name, member ID and the member’s date of birth. ODS Customer Service will utilize DMAP’s MMIS system and Benefit Tracker to verify the member’s eligibility. Faxes received by 5 PM will be returned no later than 9 AM on the following business day.

PLEASE NOTE: ODS receives daily eligibility updates and will be reflected in the Benefit Tracker system. ODS advises that whichever option you choose, you also obtain a photocopy of the Member’s ID card and photo ID for each visit.

MMIS Display

MMIS will no longer show which dental plan a member has been assigned to but will rather show which CCO they are assigned to as well as the type of coverage they have.

• CCOA – Mental, medical, and dental health coverage
• CCOB – Mental and medical health coverage
• CCOC – Medical and dental health coverage
• CCOD – Medical health coverage
• CCOE – Mental health coverage
• CCOF – Dental only (not yet implemented)
• CCOG – Mental and dental health

If your patient is unsure of which dental plan they enrolled with, you can contact the CCO that is showing under the Managed Care section on MMIS. Their customer service numbers are listed for your convenience.

Dentists using the MMIS website for eligibility should also use Benefit Tracker to complete the eligibility verification.

CCO Directory

AllCare Health Plan

Partnered with ODS Community Health 10/01/2013
Counties–Curry, Douglas, Jackson, and Josephine
ID cards – AllCare
Member Handbooks – AllCare
Phone number – 1-888-460-0185

Intercommunity Health Network – IHN

Partnered with ODS Community Health 10/01/2013
Counties-Benton, Lincoln, and Linn
New Group Number – 10010448
ID cards – ODS
Member Handbooks – ODS
Phone Number – 1-800-832-4580

PrimaryHealth of Josephine County

Partnered with ODS Community Health 10/01/2013
Counties-Douglas, Jackson, and Josephine
New Group Number – 10010450
ID cards – PrimaryHealth
Member Handbooks – ODS
Phone Number – 541-471-4208 or toll free at 1-800-471-0304

Willamette Valley Community Health – WVCH

Partnered with ODS Community Health 10/01/2013
Counties–Benton, Clackamas, Linn, Marion, Polk, and Yamhill
New Group Number – 10010449
ID cards – Willamette Valley Community Health
Member Handbooks – ODS
Phone Number – 503-584-2150 or toll free at 1-866-362-4794

FamilyCare Tricounty

Partnered with ODS Community Health 01/01/2014
Counties – Clackamas, Marion, Multnomah, Washington
New Group Number – 10010571
ID Cards – ODS
Member Handbooks – FamilyCare Tricounty
Phone Number – 800-335-3205

Health Share of Oregon

Partnered with ODS Community Health 01/01/2014
Counties – Clackamas, Multnomah, Washington
New Group Number – 10010572
ID Cards – Health Share of Oregon
Member Handbooks – Health Share of Oregon
Phone Number – 888-519-3845

Jackson Care Connect

Partnered with ODS Community Health 01/01/2014
County – Jackson
New Group Number – 10010573
ID Cards – Jackson Care Connect
Member Handbooks – ODS Community Health
Phone Number – 855-722-8205

Columbia Pacific

Partnered with ODS Community Health 04/01/2014
Counties – Clatsop, Columbia and Tillamook
New Group Number – 10011141
ID Cards – Columbia Pacific (exception, ODS in Clatsop and Columbia counties)
Member Handbooks – Columbia Pacific
Phone Number – 855-722-8206

Trillium Community Health Plan

Partnered with ODS Community Health 04/01/2014
Counties – Benton, Lane and Linn
New Group Number – 10010446
ID Cards – Trillium Community Health Plan
Member Handbooks – Trillium Community Health Plan
Phone Number – 877-600-5472

Eastern Oregon Coordinated Care Organization

Partnered with ODS Community Health 07/01/2014
Counties – Baker, Gilliam, Grant, Harney, Lake, Malheur, Morrow, Sherman, Umatilla, Union, Wallowa and Wheeler
New Group Number – 10009552
ID Cards – EOCCO
Member Handbooks – EOCCO
Phone Number – 888-788-9821

PacificSource Community Solutions

Partnered with ODS Community Health 07/01/2014
Counties – Crook, Deschutes, Hood River, Jefferson, Klamath and Wasco
New Group Number(s) – 10011719 for Columbia Gorge area and 10011720 for Central Oregon area
ID Cards – PacificSource Community Solutions
Member Handbooks – PacificSource Community Solutions
Phone Number – 800-431-4135

Yamhill County Care Organization

Partnered with ODS Community Health 07/01/2014
Counties – Clackamas, Marion, Washington and Yamhill
ID Cards – Yamhill County Care Organization
Member Handbooks – Yamhill County Care Organization
Phone Number – 855-722-8205