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2023 Coordinated Care Organization Changes for Providers

What Is Changing?

Starting Jan. 1, 2023, coordinated care organizations (CCOs) will manage dental care for more Oregon Health Plan (OHP) members.

Some Oregon Health Plan (OHP) members use plans called dental care organizations or DCOs. CCOs will now manage dental care for these members.

  • DCO members will move to a CCO for their dental care.
  • The CCO will assign members to one of their local dental networks.
  • This change will be for a very small number of OHP members (less than 4%).​

Learn more about this change​.

People eligible for OHP Plus dental-only benefits will have the OHP Dental benefit plan (benefit plan code DEN or DNT). They will have the same dental benefits and access to dental care as other OHP members. Learn more about the new dental programs.

These dental plans do not work with local CCOs, so they will no longer serve OHP members in the tri-county area:
  • Family Dental Care
  • Managed Dental Care of Oregon

These members can choose to get dental care through their current CCO or a different one in their area.

Benefits and Covered Services

Benefits and covered services will remain the same. Each CCO’s specific policies may differ, but coverage must include all benefits defined in the Oregon Health Plan benefit packageand cover these benefits for funded conditions on or above Line 472 of the Prioritized List of Health Services.

Contact the CCO to learn about each CCO's specific coverage policies and procedures.

If a CCO denies your claim or authorization request, please contact the CCO to appeal the decision according to their specific process.

If you have appealed the CCO's decision and still think the CCO should cover the service:

​For policies related to Prioritized List coverage, benefit coverage or exclusions, see the General Rules, Oregon Health Plan rules, and the provider guidelines specific to your program.

To find out whether a specific procedure is potentially covered according to the Prioritized List, providers can use the HSC List inquiry on the Provider Web Portal at or call the OHP Code Pairing and Prioritized List Hotline at 800-336-6016.

To learn more about identifying a member's OHP benefits, read OHA's one-page overview of how to read benefit plan, managed care enrollment, service coverage and TPL information​. More resources by topic are on the OHP Eligibility Verification page.

For prohibitions against billing OHP members, see OHA's Do's and Donts and fact sheet about OHP and Qualified Medicare Beneficiaries​.

Continuity of Care

Starting Jan. 1, 2023:

  • CCOs will honor all existing service authorizations for dental care from the member’s 2022 DCO for up to six months.
  • Members will be able to see their current dental provider for up to 90 days.

This is true even if the member’s current provider does not join the one of CCO's dental networks for 2023.

Read OHA's fact sheet about continuity of care»

For services approved or rendered in 2022, contact the member's 2022 DCO.

For questions about resolving 2022 claims with closing DCOs, contact the closing DCO:

For 2023 services, contact the member's 2023 CCO for dental care.

For prescription access help, call the Oregon Pharmacy Call Center at 888-202-2126.

What Providers Can Do

Your patients may ask which CCOs you work with. Members in areas with more than one CCO may still be able to choose a different CCO after March 31, 2023. Learn more about changing CCO or dental plan enrollment.

​We have received questions from providers who are in areas where OHP members are likely to be served by multiple CCOs. Providers have asked how to respond to OHP members seeking guidance on how to make their CCO selection:

  • Do: Let OHP members know which CCO dental networks you work with so they can make an informed choice. 
  • Don’t: Encourage OHP members to sign up with a specific CCO. OHP members will weigh a variety of factors in making their selections, including other provider relationships. Any provider communications intended to encourage members to sign up with a specific CCO must be reviewed by the CCO and if needed, by OHA. To learn more, read our fact sheet.
  • Do: Encourage members to learn about their choices and get help by calling OHP Client Services at 800-273-0557 (TTY 711) or from a local community partner organization. You can review the information members have received in the "Sample member letters" section of this page.

​Starting Jan. 1, 2023, please be sure to continue serving all OHP members, regardless of their specific CCO enrollment.

  • Continue to see members and schedule appointments as usual for all dental care, including proceeding with planned appointments, treatments and procedures.
  • Submit new prior authorization (PA) requests, treatment plans and prescription authorizations to the member’s new CCO.
  • For members changing to a new provider, arrange for orderly transfer of all required records and information to the member’s new provider.

Do not cancel or refuse to make appointments because a patient is changing dental networks.

Read OHA's fact sheet about continuity of care»

Contact the CCO to ask about their:

  • Provider enrollment/credentialing requirements and timelines
  • Billing, authorization and coverage policies and procedures
  • Point of sale, billing, eligibility and other electronic health care transactions
  • Other requirements such as reporting and member notification

Credentialing Information

To learn about each CCO’s credentialing and provider participation requirements, contact the CCO.

Dental providers can learn how to participate with their local CCOs at these links:

If you are denied participation in a CCO, please first contact the CCO and complete their appeal process.

If you have appealed the CCO's decision and believe the decision was based on your specific license or certification, you can submit a Provider Discrimination Review Request to OHA.