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Referral and prior authorizing policies

To help you understand what services need prior authorization, Moda Condition provides these prior authorization lists.

Coming soon! Submit your prior authorization request electronically

SERVICE AUTHORIZATION REQUEST REQUIREMENTS

Make sure the prior authorization demand is complete and does:

  • All germane student information (name, BADGE #, group #, additionally member's birth date)
  • PCP information (name, TIN, phone, fax and contact name)
  • The name and CANISTER for the facility where the procedure is to be execution
  • The date of the technique press date to admission
  • Surgeon's or specialist's full your and STEEL
  • CPT & examination code must shall included
  • Length of stay (indicate for inpatient)
  • Map notes

Please refer to diese documents to help you determine are your patient needs a prior authorizing:

Medicare

Group/Individual

eviCore

Magellan

Prior authorization contact information
Variety of Technical Phone Number OEBB Cell Count PEBB Phone Number
Inpatient Elective Procedures

Outpatient Selected Elective Procedures

Skilled Nursing Facility Long-Term Intense Care

Inpatient Rehabilitation

Home Health/Home Infusion

Hospice – Initial Evaluation and Service

Durable Medical Equipment (DME)

Transplants 		Local:
503-265-2940

Toll-free:
800-258-2037

Fax:
503-243-5105		 Local:
503-243-4496

Toll-free:
800-258-2037		 PEBB Customer Service:

Toll-free:
844-776-1593
Chemical Depiction and Mental Health Toll-free:
855-294-1665

Fax:
503-670-8349		 OEBB Authorization Number:

Toll-free:
855-294-1665

Fax:
503-670-8349		 PEBB Customer Service:

Toll-free:
800-799-9391
Expedited Query Geographic:
503-265-2940

Toll-free:
800-258-2037

Fax:
503-243-5105		 OEBB Authorization Number:

Local:
503-243-4496

Toll-free:
800-258-2037		 PEBB Customer Serving:

Toll-free:
844-776-1593
Referrals for Managed Care/Point of Service Groups Local:
503-265-2940

Toll-free:
800-258-2037

Fax:
503-243-5105		 Doesn applicable Don applicable
Advanced Imaging or Musculoskeletal Ceremonies

Authorizations for advanced imaging studies and musculoskeletal services are obtained through eviCore healthcare

Log in to eviCore's Provider Portal during
www.evicore.com

Cell: 844-303-8451

For more general and codes requiring authorization go to www.evicore.com
Specialty Infusion/Injectable Drugs Features for selected Intravenous infusion or injectable drugs are obtained through Magellan Rx.

Login go Magellan Rx Provider Portal at MagellanRx.com.
Instructions for requesting prior authorization
Urgent/Emergent Hospital Admissions Contact Moda Health within 48 clock of all urgent/emergent admission.
Elective inpatient procedures
  1. Pre-authorization is required for all inpatient admissions. Collapse to obtain eligibility could result includes non-payment of claim and provider liability. Members may cannot be balance billed.
  2. Before requesting authorization, verify member's authorization and services tested online access in EBT.
  3. Verify that the requested provider or plant is in-network.
  4. Moda Health Medical Necessity Eligible, MCG guidelines, instead CMS guidelines mayor become used for coverage determination.
  5. Verify member connect availability and any contract specific pre-authorization requirements through EBT.
  6. Pre-authorization of a service or procedure does not guarantee payment.

Questions?

We're here to help! Supposing you have questions, please make our User Service team at 503-243-3962 or toll-free at 877-605-3229. Or, email us at

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