Hello DentaQuest Medicaid Provider of Ortho Services,
The Ohio Department of Medicaid (ODM) revised Form 03630 in September 2025 for a
January 1, 2026, effective date. The “Revised ODM Form 03630” replaces all previously existing versions of Form 03630 and their included criteria. Please find the new FINAL Form 03630 below. This form will also be included in your DentaQuest Provider Portal.
Important to note:
- ODM has updated their documentation requirements for what needs to be included with all ortho case submissions.
- ODM has worked with all MCOs to finalize an updated process for submitting Ortho cases.
- The new Ortho process goes into effect January 1, 2026 and will be REQUIRED on all cases submitted moving forward.
- There will be 2 live webinar trainings offered. Please mark your calendars to attend one of these sessions. The login instructions will be emailed next week to you:
- Tuesday 12/9 (12:00 p.m. ET). Duration 45 mins
- Wednesday 12/17 (12:00 p.m. ET). Duration 45 mins
- After the sessions, the training will be posted on the public website for Dentaquest.com on the Ohio Provider Page for online access. A linked will be provided after the training sessions.
Viewing the training webinar or one of the live sessions is recommended so that providers can be aware of what will be needed effective January 1, 2026.
Please watch for the email invite for logging into one of the two training sessions. We look forward to seeing you at the online session and addressing any questions you may have. If you have questions in the meantime, please reach out to the DentaQuest OH Provider Services call center or your DentaQuest provider engagement team at OHProviderEngagement@dentaquest.com.
Thank you,
DentaQuest Ohio Provider Team
Cheryl Polmatier, AVP
