Oregon  |  July/August 2016
Preparing for the flu season
Vaccinations are important for preventing disease. Because Moda is committed to the health of our members, we offer immunization services through in-network providers and pharmacies for zero out-of-pocket expenses for most Moda plans.

With the 2016-2017 flu season approaching, here are some important updates to keep in mind:
  • In June, the Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP) voted that live attenuated influenza vaccine (LAIV), known as the "nasal spray" flu vaccine, should not be used during the 2016-17 flu season. Instead, the standard flu shot should be used for those six months of age and older.
  • This decision was based on data from the 2015-16 season showing the limited effectiveness of LAIV among participants at 3% (95% CI, -49% to 37%) in children ages 2 to 17 compared to the standard flu shot, or inactivated influenza virus at 63% (95% CI, 52% to 72%). The American Academy of Pediatrics supports this recommendation.
About Ardon Health, our specialty pharmacy
Ardon Health is here to help patients on their health journey - and assist you throughout the process of referring and treating your patients.
With Ardon's concierge specialty prescription services, you can expect fast and easy service that saves you time. Just send them a prescription and they'll do the rest. Services include:
  • Prescription benefits investigation and issue resolution
  • Prior authorization coordination
  • Financial and copay assistance for patients
  • 24/7 patient access to experienced pharmacists
  • Disease-specific individual care plans
  • Tailored medication counseling
  • Adherence monitoring and support
  • Side effect evaluation and interventions
  • Next-day medication delivery
  • Proactive refill planning and coordination
Ardon's clinical team also monitors your patients and will contact your office if there is any concern with side effects, drug interactions, adherence issues or signs of disease progression. Ardon does all this so you can focus on caring for your patients.  
Not sure which specialty pharmacy your patient can use?
No problem. When you send Ardon a prescription, they investigate your patient's benefits. If the patient can't use Ardon, they'll transfer the prescription to the appropriate pharmacy.
Have questions about what financial assistance is available to your patients?
Just call Ardon and they'll let you know. Connecting patients with financial and copay assistance programs is routine for them. By easing the financial burden of special medications, Ardon makes it easier for patients to follow their treatment plan.
Please call toll-free at 855-425-4085 or email info@ardonhealth.com . TTY users, please call 711.
Business hours:
Monday - Friday, 8 a.m. to 7 p.m. PT
Saturday, 8 a.m. to noon PT
Ardon is closed Sundays and all major holidays
24/7 pharmacist availability
New provider-administered medications added for prior authorization 
As part of our commitment to providing our members with high-quality, affordable care, we've partnered with Magellan Rx Management to assist you in medical pharmacy management through the provider administered injectable drug program. We will also continue to implement updates to the review and approval processes of certain injectable medications.
Effective October 1, 2016, nine new medications will be added to the prior authorization list of medications currently in the Magellan Rx program. Please visit our website to view the complete list.

Magellan Rx will review your prior authorization requests for 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
Completing prior authorization requests through Magellan Rx will help expedite claims processing and doesn't require you to submit medical records. If you don't obtain a prior authorization, your claims may be delayed or denied until we receive the information needed to establish medical necessity. 
To learn more about our injectable drug program, please check out our Injectable Drug Program FAQ.
We appreciate your support in assuring our members receive quality care. If you have any questions, please call our Customer Service team toll-free at 800-258-2037.
Medical necessity criteria update
Interspinous Process Decompression Systems (e.g. X STOP®), and interlaminar stabilization devices (e.g. Coflex®), are minimally invasive surgical procedures designed to alleviate painful symptoms of lumbar spinal stenosis.

Evidence-based literature has not demonstrated that interspinous process decompression devices or interlaminar stabilization systems provide significant advantage over surgical decompression or fusion. Starting October 1, 2016, Moda will consider CPT0171T (insertion of posterior spinous process distraction device) and CPT C1821 (interspinous process distraction device) investigational.

Click here to view Moda's medical necessity criteria for Interspinous Process Decompression Systems. You may also visit our medical necessity criteria page to view the current medical criteria for our commercial plans.  
E-Prescribing tool now available to prescribers
In July, we introduced a new tool to help prescribers send electronic prescriptions to pharmacies rather than using conventional handwritten or faxed prescriptions.
Moda's e-Prescribing platform can improve the accuracy of prescriptions, minimize common medication errors and eliminate delays in patient care. Prescribers can also access Moda's formulary and a member's benefit design before writing a prescription. This helps increase formulary compliance and reduce any disruptions or delays. Plus, prescribers can view a patient's complete medication history and profile across dispensing pharmacies to assess medication adherence, identify gaps in therapy, eliminate potential duplicate or ineffective therapies, and reconcile the patient's prescription use at each prescribing event.
Protecting your patients' PHI 
Moda takes protecting each member's personal health information (PHI) seriously. As our healthcare partner, we recognize and appreciate that you do, too. The Health Insurance Portability and Accountability Act (HIPAA) requires physicians to protect the confidentiality of their patients' PHI, and to stay on top of any issues related to potential security breaches.

To that end, please review the recent Medicare Learning Network article, which reminds physicians using electronic systems the importance of storing and protecting our patients' valuable PHI.
Medicare Compliance Attestation starts in August
The Centers for Medicare & Medicaid Services (CMS) requires healthcare providers and facilities that contract with Medicare Advantage plans to complete Medicare compliance requirements each year. We asks that all of our contracted providers and facilities complete the annual attestation to ensure we've met these important Medicare requirements.
As a contracted healthcare provider/facility with Moda's Medicare Advantage plans, please follow the steps listed on the attestation form and provide your completed attestation to the Moda Provider Relations by Oct. 1, 2016.
Questions about Medicare Compliance Program requirements? 
We're here to help. Please email our Medicare Compliance team at delegatecompliance@modahealth.com.
Questions about the Medicare attestation form?
No problem. Please email our Provider Relations team at providerattestation@modahealth.com.

Want more information on the Medicare Compliance Program? 
Please visit our Medicare Compliance Program website today.
In this issue
2016 Provider workshops are just around the corner 
Moda's 2016 Medical Provider Workshops are set to begin September 13, 2016. Join us to learn about our 2016 updates and get a glimpse of what's ahead for 2017.

Be sure to visit our workshop website to sign up for a workshop near you to get a seat today.
Join our email list
Visit our website  and click on "Join our email list" in order to begin receiving bi-monthy newsletters, as well as occasional electronic communications.
Help us keep your practice details up to date
To ensure that 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 to have the most up-to-date information about your practice or facility available to 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 ensure that our members can locate providers that are available and best suit their needs.
Go digital today!
If you would like to start exchanging information electronically with Moda, please contact the Moda Electronic Data Interchange team at 
Moda Contact Information 
Moda Medical Customer Service
For claims review, adjustment requests and/or billing policies, call 
(888) 217-2363 or email medical@modahealth.com.
Moda Provider Services
To reach our Provider Services department, please email 

Medical Professional Configuration
For provider demographic and address updates email 
Credentialing Department
For credentialing questions and requests, please email 
601 S.W. Second Avenue
Portland, OR 97204