Oregon | September/October 2017 
New look to Benefit Tracker

We’d like to share some exciting changes to the way you view benefits for Moda Health members. We have visually refreshed our Benefit Tracker tool to provide a more streamlined experience. Although Benefit Tracker looks different, all functionality remains the same.

Simplified navigation
You’ll notice we’ve simplified navigating the Benefit Tracker tool by increasing font size, updating colors and consolidating links to make it easier to find what you are looking for, with fewer clicks.

Benefit Tracker user profile
All Benefit Tracker user profile links are now in a single drop-down menu.

Viewing member benefits
Once you’ve located a member’s benefit profile, you will notice that we’ve updated several pieces within the Benefit overview section, including:

  • Expanded claim search feature: To expand or reduce the number of results when searching a member’s claim history, scroll to the bottom of the claim search result page, click the drop-down result menu, and select how many claims you’d like to view at once.
  • Seeing claim details: To view claim details, simply click anywhere within the claim row.
  • Printing claim details: Select “Print to PDF” for a print-friendly document.
  • Displaying explanation codes: Explanation codes are now listed next to the claim.
We’re here to help. To learn more about Benefit Tracker or to provide feedback, please contact our customer service team at 877-605-3229 or by email at ebt@modahealth.com
Flu shot season is here!

With flu season upon us, it’s time to guide your patients to take preventive action against the flu. Research by the U.S. Flu Vaccine Effective Network shows that vaccinations reduce the overall risk of flu-related medical visits by 42 percent. Vaccinations also offer significant protection against flu-related hospitalizations, with a 30 percent drop in all adults and 37 percent drop in adults age 65 years and older. Over the past two flu seasons, major strains in the Pacific Northwest have been reflective of what’s been seen throughout the nation.

  • Flu vaccines are recommended for all persons aged > 6 months.
  • Emphasis should be placed on high-risk groups, including:
  • Children ages six months to five years, adults age > 50 years, women who are or will be pregnant during the flu season, persons with chronic conditions, are immunocompromised or are extremely obese
  • The CDC recommends against the use of FluMist Quadrivalent (LAIV4).

  • Flu vaccines are typically covered under the pharmacy benefit.
  • Pharmacists are able to give flu shots to patients age seven and older.
  • The majority of members may qualify for a $0 copay.
Injectable medication program expansion

Effective Nov. 1, 2017 , five new medications will be added to the   prior authorization list of medications currently in the Magellan Rx program. Magellan Rx will review your prior authorization requests for these specialty injectable medications, along with other specialty medications that are already part of the program when administered in:

  • An outpatient facility
  • A patient's home
  • A physician's office

The new prior authorization medications include:
Prior authorization list updates

The following services will been added to our prior authorization list. See our current list of prior authorization services here .

CPAP/Auto-PAP - Effective November 15, 2017, CPAP and Auto-PAP (E0601) for the treatment of Obstructive Sleep Apnea will require prior authorization.
Proleukin – Effective December 1, 2017, Proleukin (J9015) will require prior authorization through Magellan RX for all fully insured groups and individuals. All other groups will contact Moda Health for prior authorization.
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

New look to Benefit Tracker

Flu shot season is here!

Injectable medication program expansion

Prior authorization list updates

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
providerupdates@modahealth.com 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.

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