Claims, complaints and appeals
We want to make sure you have everything you need to provide our members with the best service. See how to submit a claim. And, find out how to direct your patients to file a complaint and appeal.
How to submit a claim
Please use the most recent American Dental Association® (ADA) Dental Claim form to submit a claim. You can also submit claims electronically. To do so, please contact our electronic data interchange (EDI) team at 800-852-5195.
We must receive all eligible claims for covered services in our office within four months from the date of service. Please note that we will not be able to pay claims received later than four months from the date of service.
Paying claims
If your billing office has not received our payment disbursement register (PDR) within 45 days of submitting a claim, they should contact our customer service team at 800-342-0526. They can also check Benefit Tracker to make sure that we have received the claim.
Please make sure that we received your initial claim. If we have not, then you may submit a duplicate claim.
Please send paper dental claims to:
ODS Community Dental Claims
P.O. Box 40384
Portland, OR 97204
Please submit electronic claims using the Electronic Data Interchange:
Learn more by calling 503-228-6554 or 800-852-5195.
You can also email edigroup@modahealth.com.
Learn more about claims in your provider handbook.
How to file a complaint
Members can file a complaint if they are not satisfied with us or a provider for anything that does not involve a denial, limitation, reduction or termination of a requested covered service. Examples of complaints include, access to providers, waiting times, demeanor of dental care personnel, quality of care and adequacy of facilities.
We encourage providers to resolve complaints, problems and concerns with their ODS Community Dental patients. If you are not able to resolve a complaint, please let the patient know that we have a formal complaint procedure. Members can submit their complaint by contacting our customer service team at 800-342-0526.
How to make an appeal
Our members or their representatives can submit a request for ODS Community Dental to review a claim denial. They need to do this in writing within 45 days of the decision. If the member calls our customer service team, they will still need to make a written appeal. You may also appeal on behalf of the member, with their permission.
Please send complaints and appeals to:
Attention: Appeals Unit
P.O. Box 40384
Portland, OR 97240
Learn more about complaints and appeals in your provider handbook.
Contact us
We’re here for you, and we want to help.