February 2013

February is American Heart Month 

Heart disease kills an estimated 630,000 Americans each year. It's the leading cause of death for both men and women. To prevent heart disease and increase awareness of its affects, ODS Health is proudly participating in American Heart Month. You can make healthy changes to lower your risk of developing heart disease. 

  • Watch your weight
  • Quit smoking and stay away from secondhand smoke
  • Control your cholesterol and blood pressure
  • If you drink alcohol, drink only in moderation
  • Get active and eat healthy
  • Manage stress

 ODS is becoming Moda Health

We'd like to share some exciting news with you. This spring, ODS is changing its name to Moda Health. It's our first step toward a fresh brand promise to you, our medical providers, and to your patients.


Why are we changing our name?

Our name says a lot about what we do. In 1955, Oregon Dental Service revolutionized dental insurance. Today, thanks to our strong partnership with the medical community, we've grown to do business beyond Oregon and offer a variety of high-quality medical, dental and pharmacy plans.


The name Moda comes from the Latin term "modus." It means "the way." In a healthcare landscape that's changing every day, our members are asking for more from us - and so are the doctors, hospitals and other medical providers we partner with. Our new name demonstrates our promise to help your patients find the best way to better health.


The most important thing to note is that everything you know and love about ODS will not change. We're the same company, run by the same people, with the same devotion to customer service. We're simply changing our name to better reflect who we are and the customers we serve.


We'll tell our members about our new name in March, before announcing it to the public this spring. But it will take about a year to fully transition to Moda Health. During this time, you'll notice that we'll refer to both ODS and Moda Health.


We'd like to ask you to help us spread the message of our new name and help your patients understand that our transformation is a reflection of how we'll serve you, them and our entire community - better than ever.



If you have questions regarding your contract, please contact Medical Professional Relations at 877.664.4762

For all other questions, please contact Medical Customer Service

Medical necessity criteria updates

ODS Health posts an updated listing of medical necessity criteria information in the Provider Resources section of our website at www.odscompanies.com/medical/medical_criteria.shtml.

Effective February 1, 2013, ODS has revised and posted the medical necessity criteria for the following:

  1. Anesthesia for Routine Gastrointestinal Endoscopic Procedure Anesthesia. https://www.odscompanies.com/medical/medical_criteria.shtml
  2. Obstructive Sleep Apnea Non-surgical Treatment https://www.odscompanies.com/medical/medical_criteria.shtml

For more information, please visit us online or call Customer Service at 503-243-3962.

Requirements on radiation therapy claims

A number of common radiation therapy codes cannot be reported by the facility or the physician unless the medical record contains specific documentation of the physician's participation, verification, review, and/or approval, etc. Other codes also require documentation of dosimetry calculations, number and type of treatment devices, etc. The documentation guidelines and recommendations of ASTRO/ACR's Guide to Radiology Oncology Coding are utilized as the basis for the review of these radiation therapy claims.

Only one claim needed under dual eligibility

Some members have dual eligibility with ODS Health. For example, if both spouses have coverage for the entire family under ODS plans then ODS is both the primary plan and the secondary insurance carrier. When this happens, only one claim needs to be submitted to ODS. When the claim is received, ODS identifies that dual eligibility exists and processes the claim under both the primary plan and the secondary plan. 


Due to a variety of factors, reimbursement under the secondary plan will often not appear on the same check and/or PDR as the claim processed under the primary plan. This does not mean that the secondary claim has been overlooked or lost, so please do not resubmit a duplicate claim. If more than 30 days has passed since reimbursement was received on the primary claim and you have not yet received a PDR for the secondary claim, you may contact our Customer Service team and inquire about the status of the secondary claim. Please have the PDR for the primary claim handy when you call.

ODS Electronic Data Exchange update 

If you are not currently exchanging information electronically with ODS Health, but would like to, please contact the ODS Electronic Data Interchange team at edigroup@odscompanies.com

ODS Medical Professional Configuration

For CPT code allowables, and pricing, call 503-265-5711 or email contractpricing@odscomapnies.com 

For provider updates, call 503-265-5711 or email providerupdates@odscomapnies.com  


Credentialing Department
For credentialing questions 
and requests, call 1-855-801-2993
or email


ODS Medical Customer Service team

All other inquires, including claims review, adjustment requests, and/or billing policies, call 503-243-3962
Disclaimer: Not all plans have access to all resources or tools referenced in this newsletter. Please refer to your Member Handbook, or call your ODS Sales and Account Services Representative for plan-specific information.

Issue 4  

In this issue:
American Heart Month
Moda Health
Medical necessity criteria updates

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To contact an ODS Benefit Tracker Administrator, call 503-265-5616, toll-free at 877-277-7270 or email