Oregon | May/June 2017 
Provider workshops coming this fall

Your Moda Provider Relations team is gearing up for our 2017 provider workshops. For your convenience, these workshops will be held at several locations throughout Oregon beginning in October.

Look for your invitation in the coming weeks. Space is limited, so please RSVP as soon as possible. You can also  check our workshops website for updates. We look forward to seeing you there.

Credentialing workflow update

As of July 15, Moda will begin processing new credentialing and recredentialing applications for practitioners.

Credentialing applications currently in process and submitted to Medversant before July 15 will be reviewed and completed by Medversant through July 31. Any credentialing application that is not completed by Medversant by July 31 will be transferred to and processed by Moda. 

To check the status of an existing credentialing application with Medversant, please call 888-308-3895. After July 15, new credentialing and recredentialing applications may be submitted by email to credentialing@modahealth.com or by fax to 503-265-5707. You may also mail your application to:

Moda Health
Attn: Credentialing Department 
601 S.W. 2nd Ave.
Portland, OR 97204

For more information about credentialing with Moda, please email credentialing@modahealth.com or call us toll free at 855-801-2993.

Coming in August: 2017 Medicare Compliance Attestation

We take compliance seriously at Moda Heath, and we appreciate that you do as well. The Centers for Medicare & Medicaid Services (CMS) requires health care providers or facilities that contract with Medicare Advantage Plans, like Moda Health, to complete Medicare compliance requirements throughout the year. Moda Health asks our contracted providers or facilities to complete an annual Medicare Compliance Attestation to demonstrate that the provider or facility completed its Medicare compliance requirements.

For questions about Moda Health Medicare Compliance Program requirements, please contact our Medicare Compliance Department at delegatecompliance@modahealth.com.                

For any additional questions, please contact the Moda Health Provider Relations Department at providerattestation@modahealth.com

The Moda Health Medicare Compliance Program website is also available to all contracted providers and facilities at www.modahealth.com/compliance.  

Highlighting HEDIS Measures for Comprehensive Diabetes Care

Each year, 1.4 million Americans are diagnosed with diabetes. Providers understand that it is a complex and demanding disease and that patients need to have comprehensive care in order to maintain control of their condition. 

Measure Definition: This measure looks at several aspects for monitoring and screening patients with diabetes who are 18 to 75 years of age. The measure looks for the percentage of members with type 1 or type 2 diabetes who had each of the following during the year:
  • Hemoglobin A1c (HbA1c) testing
  • HbA1c poor control (> 9.0%)
  • HbA1c control (< 8%)
  • HbA1c control (< 7%)
  • Eye exam (retinal) performed
  • Medical attention for nephropathy
  • BP control (< 140/90 mm Hg)
Nationally recognized clinical guidelines recommend:
  • HbA1c tests three to four times per year
  • Retinal eye exam by an optometrist or ophthalmologist once per year
  • Nephropathy screening once per year
  • Blood pressure readings at each outpatient medical visit
Reasons for noncompliance:
  • Lack of communication and continuity of care between primary care and specialists
  • Test results may not have been clearly recorded in the patient's medical chart
  • Member with a prescription but no record of an office visit or lab test/result over the course of the year
  • Tests may not have been done or recommended
Provider tips:
  • Establish an office registry to identify your patients with diabetes in order to help track lab test appointments, basic results and specialists. Use this as a tool to improve coordinated care for each patient. 
  • Be diligent about recording all tests and lab results. Flag high results (HbA1c, blood pressure) and schedule return visits for at-risk members. 
  • Have MAs scrub charts before all visits in order to identify screening needs. Order tests and have prompts for optometry referrals ready at the time of the visit.
Please contact us with any questions or concerns on this or any other HEDIS measure at HEDIS@modahealth.com.
Medical necessity updates

We've recently updated our medical necessity criteria. You can find the following changes at our medical necessity criteria website.
Moda Contact Information

Moda Medical Customer Service
For claims review, adjustment requests and/or billing policies, please call 888-217-2363 or email  medical@modahealth.com.

Moda Provider Services
To reach our Provider Services department, please email providerrelations@modahealth.com.

Medical Professional Configuration
For provider demographic and address updates, please email providerupdates@modahealth.com.

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

In this Issue

Provider workshops coming this fall

Credentialing workflow update

Coming in August: 2017 Medicare Compliance Attestation

Highlighting HEDIS Measures for Comprehensive Diabetes Care

Medical necessity updates
Go digital today!

If you want to start exchanging information electronically with Moda, please contact the Moda Electronic Data Interchange team at edigroup@modahealth.com
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Help us keep your practice details updated

To make sure we provide high-quality service to our members, Moda's "Find a Provider" online search tool helps members connect with our extensive network of contracted providers. To meet the CMS requirement of having updated information about your practice or facility for our members, please email our provider updates team at
when any of the following changes occur, including the effective date:
  • New street address, phone number or office hours
  • Changes in the "When you are accepting new patients" status for all contracted Moda lines of business
  • Changes that affect the availability of providers in your practice

This will help make sure our members can find providers that are available and best suit their needs.

601 S.W. Second Avenue
Portland, OR 97204
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