Moda Medical Office Update

Updated credentialing and recredentialing applications

As of April 23, 2023, updated versions of the Oregon Practitioner Credentialing Application (OPCA) and Recredentialing Application (OPRA) have been mandated for use by credentialing entities.

These applications were created by the Advisory Committee on Physician Credentialing Information (ACPCI) and are required by hospitals and health plans to credential and recredential practitioners in the State of Oregon. Previous versions of these applications are no longer valid.

Visit the Oregon Health Authority’s website to learn more and to download the current OPCA and OPRA applications.

Questions?

For questions about to the credentialing process, please contact the Moda Health Credentialing Team at [email protected].

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.

The good news is the Oregon Health & Science University Addiction Medicine ECHO Program offers a free

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 [email protected] 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.

Moda Health sets up a Secure File Transfer Protocol (SFTP) site to connect your data with our internal data warehouse.
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.
We review the quality and integrity of your data. Once validated, the process is automated to ensure accurate monthly reports.
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 [email protected] 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 [email protected] 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:

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
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
Report adverse events or quality problems with any medicine to FDA’s MedWatch Adverse Event Reporting program
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)