By a written contract, each dentist agrees to provide quality care to Delta Dental of Oregon members. Each dentist also agrees to prefile his or her fees and accept direct reimbursement from Delta Dental.

• Rules for participating dentists
• Credentialing requirements

Rules for Participating Dentists

Participating dentists agree to abide by the following rules of Oregon Dental Service, 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 an 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.

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Credentialing Requirements

Delta Dental maintains a file of your credentialing information. The credentialing form must be filled out and returned to Delta Dental as a part of your participating agreement. Delta Dental will verify your credentials every three years — please use the recredentialing form after your first filing.

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