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EFFECTIVE: April 1, 2017

eviCore Healthcare

As part of Moda Health's efforts to provide our plan holders with access to high-quality, cost-effective care, beginning April 1, 2017 we will be replacing AIM Specialty Health with eviCore healthcare, a specialty medical benefits management company that provides utilization management services.

You may verify if your patient is employed by a group that requires prior authorization for services through eviCore. Just log in to Benefit Tracker for specific member benefits information, or call our Customer Service team toll-free at 800-258-2037.

eviCore advanced imaging program

Applicable to ASO and all fully insured commercial, Medicare Advantage, and EOCCO/Medicaid members, we will require that all prior authorization requests for the advanced imaging services listed below be placed through eviCore for dates of service beginning April 1, 2017. eviCore will begin accepting prior authorization requests on March 27, 2017

You may verify if your patient is employed by a group that requires prior authorization for services through eviCore. Just log in to Benefit Tracker for specific member benefits information, or call our Customer Service team toll-free at 800-258-2037.

Please note: Services performed without prior authorization will be denied to provider write-off and members may not be billed for these services.

Please see the following list of advanced imaging CPT codes that require prior authorization:

eviCore musculoskeletal program

eviCore's musculoskeletal utilization management program manages outpatient services for physical therapy, occupational therapy, speech therapy, massage therapy, acupuncture, spine surgery, chiropractic, pain management and joint surgery management.

You may verify if your patient is employed by a group that requires prior authorization for services through eviCore. Just log in to Benefit Tracker for specific member benefits information, or call our Customer Service team toll-free at 800-258-2037.

For authorizations regarding intensive outpatient rehabilitation for the treatment of autism spectrum disorder or neurodevelopmental conditions, please contact Moda Health for authorization.

Please note: Services performed without prior authorization will be denied to provider write-off and members may not be billed for these services.

Please see the following list of musculoskeletal CPT codes that require prior authorization:

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Hello.

We have exciting news to share. ODS is changing its name to Moda Health.

Moda comes from the latin term "modus" and means "a way". We picked it because that's what we are here to do: help our communities find a way to better health.

Together, we can be more, be better.

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