OAR 410-123-1600
Managed Care Organizations

(1) The Division contracts with Managed Care Organizations (MCO) and Primary Care Managers (PCM) to provide medical services for clients under the Division (Title XIX and Title XXI services):
(a) MCOs for dental services are called Dental Care Organizations (DCO). See General Rules OAR 410-120-0250 (Managed Care Entity) – Managed Care Organizations for definitions and responsibilities of MCOs;
(b) See General Rules OAR 410-120-1210 (Medical Assistance Benefit Packages and Delivery System)(4) – Medical Assistance Programs and Delivery Systems for a description of how clients receive services through MCOs and PCMs.
(2) The Division prepays DCOs to cover dental services, including the professional component of any services provided in an Ambulatory Surgical Center (ASC) or an outpatient or inpatient hospital setting for hospital dentistry. See OAR 410-123-1490 (Hospital Dentistry) for more information about hospital dentistry.
(3) The Division will not pay for services covered by a MCO; reimbursement is a matter between the MCO and the provider.
(4) For clients enrolled in a DCO, it is the responsibility of the dental provider to coordinate all dental services with the client’s DCO prior to providing services.

Source: Rule 410-123-1600 — Managed Care Organizations, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=410-123-1600.

Last Updated

Jun. 8, 2021

Rule 410-123-1600’s source at or​.us