New training required before renewing your DEA license

Starting June 27, 2023, the Drug Enforcement Administration (DEA) has a new requirement. You’ll need to complete
a one-time, eight-hour training on managing substance use disorders (SUDs) before renewing your DEA license.
 
training with continuing medical education (CME) credits to meet this requirement.
 
The training must be completed before:
  • You apply for a DEA license for the first time on or after June 27, 2023; or
  • Your next DEA license renewal date on or after June 27, 2023
 
Once you’ve completed this training, no other training is required for future DEA renewals.
 
To learn more or to register, please visit oregonechonetwork.org.

Unlock the power of Benefit Tracker: Get patient information fast!

Need patient information in a hurry? How about at 2 a.m.? Before calling Moda Health’s Customer Service team, remember that your patients’ eligibility and benefit information is just a click away. And it’s available 24/7!
 
Benefit Tracker is a free online service that provides information about your patients’ eligibility, network, copay & deductible, PCP, claims status, and much more. However, if you need to talk to a live customer service agent, you can call the number on the patient’s ID card. They can answer any questions you have about your patients.
 
Questions?
To learn more about Benefit Tracker, please email ebt@modahealth.com or visit our website.
Earn incentives and close care gaps with ease

We’re excited to share information about our streamlined Provider Data Exchange (PDE), an automated data share program that can help you earn incentives and close critical care gaps. If you are interested in implementing this program, we’re flexible and can support any lift you need to set up the supplemental and clinical data sharing process.
 
How it works
The following steps show how easy it can be to earn incentives and close important care gaps.
  1. Moda Health sets up a Secure File Transfer Protocol (SFTP) site to connect your data with our internal data warehouse.
  2. You send your data through a dedicated site. Submit monthly or regularly in up to four categories (diagnostics, labs, vitals, and screenings and assessments). Sending your data in multiple categories increases your potential incentives.
  3.  We review the quality and integrity of your data. Once validated, the process is automated to ensure accurate monthly reports.
  4. You can access your Provider Reports Portal to view monthly reports to see measurement gap lists and track your incentive earnings.
 
Questions?
Would like to schedule a 30-minute call to learn the benefits of the PDE program? If so, please email us at valuebaseddatasharing@modahealth.com to get started.
Help protect the vision of patients with diabetes

Moda Health is committed to supporting patients with diabetes so they can live longer, healthier lives. One way to help your patients effectively manage their diabetes is to perform eye exams for people with diabetes (EED). The following resources are designed to help ensure patients with diabetes get the eye care they need to protect their vision.
 
Why is the HEDIS EED measure important?
  • Uncontrolled diabetes can cause damage to the vessels in the back of the eye, causing diabetic retinopathy (DR). DR is the leading cause of blindness among working-age adults.
  • About 1 in 3 adults over 40 with diabetes has DR
  • More than 1 in 3 DR cases include African Americans and Mexican Americans
  • The CDC recommends people with diabetes get a diabetic retinal eye exam once a year
 
What does NCQA expect?
The NCQA measure description for EED is: “The percentage of members 18-75 years of age with diabetes (type 1 or 2) who had a retinal eye exam during the measurement year.”
 
You can close gaps in care by doing one of the following:
  • A retinal or dilated eye exam by an optometrist or ophthalmologist in the measurement year
  • A negative retinal or dilated eye exam (negative for retinopathy) in the year prior to the measurement year
  • Bilateral eye enucleation anytime in the patient’s history through Dec. 31 of the measurement year
 
What CPTs should you bill?
92250: Fundus photography with interpretation and report
92227: Remote imaging of the retina to screen for retinal diseases
92228: Imagining of retina for detection of monitoring of disease, with interpretation by remote physician or other qualified health care professional
65101, 65103: Enucleation of eye
2022F: Dilated retinal eye exam with evidence of retinopathy
2023F: Dilated retinal eye exam without evidence of retinopathy
2024F: 7 standard field stereoscopic retinal photos with evidence of retinopathy
2025F: 7 standard field stereoscopic retinal photos without evidence of retinopathy
 
Resources and evidence-based clinical practice ideas
  • If you have patients with Moda insurance struggling with their diabetes, we offer health coaching services to help improve self-management, understand health and set sustainable goals. Call 855-466-7155 or email healthcoachteam@modahealth.com to learn more.
  • Talk to your patients about their diabetes care. Evidence shows that patient-shared decision making reduces care costs, enhances the patient experience, and improves diabetes-related health outcomes.
  • Just getting to appointments may impact a patient’s ability to attend. To help reduce this health disparity, create a carpool or rideshare program for patients. The U.S. Department of Transportation offers information about rideshare options and resources.
  • Our case management program assists and supports members with complex conditions or catastrophic events with a registered nurse or behavioral health specialists (also see Summit Health’s Case Management Referral form. Instructions for submission are at the bottom of each form.
 
As always, we thank you for supporting your patients in managing their health.
Recall of contaminated eye drops

The CDC and FDA recently issued an outbreak warning about a strong drug-resistant strain of pseudomonas aeruginosa that’s causing different infections, even in the eyes. 
 
The report found that many patients got sick after using EzriCare artificial tears. The manufacturer, Global Pharma, has recalled EzriCare Artificial Tears, Delsam Pharma Artificial Tears and Delsam Pharma Artificial Ointment. No other products have been linked to this outbreak.
 
Monitoring patients can help identify those who may be affected. Eye infection symptoms may include:
  • Yellow, green, or clear discharge from the eye
  • Eye pain or discomfort
  • Redness of the eye or eyelid
  • Feeling of something in your eye (foreign body sensation)
  • Increased sensitivity to light
  • Blurry vision
 
CDC and FDA recommendations:
The CDC and FDA recommend the following to help protect the health of your patients:
  1. Clinicians and patients to stop using and discard EzriCare Artificial Tears and two additional products made by the same manufacturer: Delsam Pharma’s Artificial Tears and Delsam Pharma’s Artificial Ointment
  2. Facilities and/or providers who have already administered EzriCare or Delsam Pharma’s Artificial Tears or Delsam Pharma’s Artificial Ointment to their patients should monitor for signs and symptoms of infection and perform culture and antimicrobial susceptibility testing when clinically indicated
  3. Report adverse events or quality problems with any medicine to FDA’s MedWatch Adverse Event Reporting program
  4. Patients with adverse reactions can contact FDA’s Consumer Complaint Coordinators
Reimbursement Policy Updates

The following table includes RPM updates for April to May 2023.
Policy
Summary of update
Reviewed in April 2023
Clarification, no policy changes:
RPM019, “Valid Modifier to Procedure Code Combinations”
  • Clarification added that modifiers LT and RT may not be used together on the same line item, with footnote, based on CMS instructions. CMS quote added to Coding Guidelines & Sources, source added to References & Resources.
  • Cross References: Hyperlinks added.
  • Formatting cleanup.
RPM039, “Medical Records Documentation Standards”
  • Section I.5.b: Clarified options for date of delivery with shipping/delivery service; included footnotes.
  • Coding Guidelines: 1 entry added.
  • Cross References: Hyperlinks added.
  • References & Resources: 1 entry added.
RPM057, “Modifier 50 – Bilateral Procedure”
  • Section A.2, clarification. Section A.3 & 4 added for clarification.
  • Section B.2: Guidelines clarified for bilateral indicator “1.”
  • Coding Guidelines & Sources: 2 entries added.
  • Cross References: Hyperlinks added.
  • References & Resources: 3 entries added.
RPM058, “Behavioral Health Case Management & Care Coordination”
  • Section A.5.a.ii.d) and A.5.a.iii updated with clarification of time-based versus MDM-based. coding and documentation for E/M services in response to a question from Change Healthcare PIP Insight Review team.
  • Cross References: 1 entry added. Hyperlinks to documents added.
Annual review:
RPM049, “Modifiers 73 & 74 - Discontinued Procedures for Facilities”
Section B.1: Fixed typo: Removed “Modifier 53.”
Reviewed in May 2023
Revision/update:
RPM073, “Telehealth and Telemedicine Expanded Services for COVID-19 — Updated for Public Health Emergency Ending”
Complete overhaul of policy with revised policy title resulting from President Biden’s 1/30/2023 announcement that the PHE will end on May 11, 2023, and the subsequent related information released from CMS, HHS & other relevant sources. 
Medical Necessity Criteria updates

The following table includes medical criteria updates for April 2023.
Criteria
April 2023
Medical Criteria Summary
Pharmacy/medical
Alpha-1-Antitrypsin deficiency
genetic testing (Serpina 1)
Introduction: This is an annual review
Criteria changes: No changes
Medical
Blepharoplasty and brow ptosis repair
Introduction: This is an annual review
Criteria changes: No changes
Medical
Leveling of emergency room services
Introduction: This is an annual review
Criteria changes: No changes
Medical
Electrical stimulation devices for home use
Introduction: This is an annual review
Criteria changes: Grammar changes
Medical
Hyperbaric oxygen therapy
Introduction: This is an annual review
Criteria changes: Added HBT treatment
for frostbite
Medical
Interspinous decompression and
interlaminar stabilization devices
Introduction: This is an annual review
Criteria changes: No changes
Medical
Intraoperative neurophysiologic monitoring
Introduction: This is an annual review
Criteria changes: No changes
Medical
Mechanical stretching devices
Introduction: This is an annual review
Criteria changes: Grammar updates.
No content changes.
Medical
Contact us
Moda Health Medical Customer Service
For claims review, adjustment requests and/or billing policies, please call 888-217-2363 or email medical@modahealth.com.
 
Moda Provider Relations
For escalated claim inquiries, contract interpretation, educational opportunities or onsite visit requests please email providerrelations@modahealth.com
Provider Updates
For provider demographic and address updates, please email providerupdates@modahealth.com.


Credentialing Department
For credentialing questions and requests, please email credentialing@modahealth.com.

Copyright © 2022. All Rights Reserved.