Contracting and credentialing in Oregon
Become a Delta Dental participating provider
Since 1955, we've been helping dentists provide the best possible care to their patients. By joining one of our dental networks, you have access to Benefit Tracker, our HIPAA-compliant online tool that helps you check patient eligibility, benefits, claims status, and easily submit fees online.
We direct our plan members to practices of participating dentists like yours. As an in-network dentist, your name and contact information appear in our provider directories and on the Delta Dental national website, making it easier for patients to find you.
We offer participation in our Premier, PPO, and Medicare Advantage Delta Dental networks. You choose what best suits your practice.
As a contracted dentist, you agree to provide quality care to our members, pre-file your fees, and accept direct reimbursement from Delta Dental.
Our credentialing process
Credentialing and recredentialing is a requirement of your participating agreement with Delta Dental. We accept credentialing information through the Council for Affordable Quality Healthcare’s (CAQH) online credentialing system. Or you can fill out and return the forms at DeltaDentalOR.com. Reverification of your information is required every three (3) years.
Save valuable time using CAQH
What is CAQH?
The Council for Affordable Quality Healthcare® (CAQH) is a non-profit alliance of health plans and related associations that work to streamline healthcare business. It operates as a central database where healthcare providers can submit and update their professional and practice information. This information is then shared with participating health plans and other healthcare entities that you choose.
Access your free CAQH account
Go to the ADA’s credentialing website. Under ADA credentialing service select the “Sign in to CAQH” button. Follow the steps to create a new account.
What you’ll need to get started
- CAQH- supplied provider ID number
- List of previous and current practice locations
- Identification numbers such as SSN, NPI, DEA, license number
- Scanned copies of your:
- Curriculum Vitae
- License
- DEA Certificate
- CDS Certificate
- IRS Form W-9
- Malpractice Insurance Declaration Page
- Summary of any pending or settled malpractice cases
- Any other required supporting documents
5 steps required to complete a CAQH profile
- Register with CAQH ProView
- Complete the online application and review the data
- Authorize Moda Health access to the information
- Verify the data and/or attest to it
- Upload and submit supporting documents
To keep your information up to date
CAQH requests re-attestation of your information every 120 days.
How do health plans access my information?
When completing your CAQH ProView profile, please list Moda Health as an authorized health plan to verify your information. You can also control which organizations access your information.
If you use CAQH’s system for credentialing
Please submit the provider’s full name, NPI and CAQH number to the credentialing team at credentialing@modahealth.com. Be sure to also cc our Dental Professional Relations team at DPROR@DeltaDentalOR.com.
Need help?
Please call the CAQH Support Team at 1-888-599-1771. They are available Monday through Thursday, from 7 a.m. to 9 p.m. (EST) and Friday from 7 a.m. to 7 p.m. (EST).
For direct credentialing and recredentialing with Delta Dental of Oregon
Please fill out the appropriate form and email back to us at credentialing@modahealth.com. Be sure to cc: DPROR@DeltaDentalOR.com.
Rules for participating dentists
Participating dentists agree to abide by the following rules of Delta Dental, in addition to other rules established and set forth by the Delta Dental Board of Directors:
- To submit a complete and current American Dental Association (ADA) standard dental claim form to Delta Dental at no charge to the patient
- To accept Delta Dental benefit payments for services provided
- To submit a listing of usual fees to be filed with Delta Dental for payment of dental services provided to Delta Dental covered patients. Any change in fee schedules is limited to once every six months.
- It is necessary for each dentist to agree to accept fees that are at or below the 90th percentile in order to participate on the Delta Dental panel. All fees must be accepted before participation status is granted and effective.
- To keep accurate and complete financial and patient records in a manner that meets generally accepted practices
- To allow Delta Dental access at reasonable times, upon request, to inspect and make copies of the books, records, and papers of a participating dentist relating to the dentist's fees charged to all his or her patients, to the services provided to patients and to payments received by the dentist from such patients
- To not charge a Delta Dental patient an amount in excess of the copayment, deductible, the dentist's accepted fee or the Delta Dental allowed amount
- To not submit charges to Delta Dental for payment for treatment that is not completed
- To not submit charges to Delta Dental for services for which no charge is made, or for which a charge increased because insurance is available (example: treatment of the dentist’s family member or employee) and have the patient statement reflect the same billed charges as the amount submitted to Delta Dental. For example, if a discount is offered to a patient, the discount needs to be reflected in the claim submitted to Delta Dental.
- If Delta Dental fails to pay for covered healthcare services as set forth in the subscriber's evidence of coverage or contract, the subscriber is not liable to the provider for any amounts owed by Delta Dental in accordance with the provision of ORS 750.095(2)
- To provide accurate and complete information to Delta Dental
- Notify Delta Dental immediately of changes in service location, payment address, TIN or other W-9 information. This helps ensure that patients can find you in our directories and that checks are promptly received.
Medicare Advantage Network
Visit our Medicare Advantage network page to connect with the resources you'll need to stay compliant.