User manual - Moda Health
Contents
1. Benefit next available Procedure Utilization Proc Code D9940 Group Limitations To locate benefit information specific to the member s plan you can click on the Group Limitations link located at the top of each page IMPORTANT The limitations shown on the Group Limitations page are exceptions to the Moda Health Standard Contract as specified by the group Please remember to always use this screen in conjunction with the Moda Health Standard Contract To view the Dental Standard Contract click on the Standard Contract link located on the top right hand side of the group limits screen 24 Sy bes Tracker Limits Eligibility and Benefits Group Limitations Claims Member Handbook Family Subscriber ID Insurance Type Dental Premier Subscriber Name Group Number 10006629 Group Name QEBB Eugene SD 4J Group Limitations note for tinnitations not sted on thls page plegse refer to OOS Standard Processing Policias 1117A Note 11174 Parent Group 100000016 Oregon Education Benefit Board CEBA Claims Display The claims page allows you to view your patient s claim history from your office Available information will include your office or provider s name the claim and check numbers claim status status date when the claim was last touched date of service category procedure code s amounts charged deductibles and amount paid information Simply select the claims link at the top of2. No pre existing exclusions except a 12 month waiting period for transplants Please Highlight and select the specific benefit category you wish to focus on As an example let s select the surgery option 17 some outpatient surgeries require service authorization and certain surgical procedures are covered only when performed as outpatient surgery Please contact customer service for more information and complete details In Network With In Network No Out of Network Referral Referral Type of Service Description Ins Pays Anesthesia 100 Anesthesia Facility 100 Refractive Surgery NA Urgeaon 100 Surgery Outpatient Ophthalmologist 100 second Opinion Office 100 urgical Supplies Outpatient 100 In this example you will now see the detailed benefit listings for surgery At the top will be displayed any specific plan notes that will need to be followed regarding coverage Some plans will display a limit category that will advise how many visits a member is allowed and how may are remaining within the benefit period In the Type of Service Description is displayed e The description of the services in question e The percentage Moda will cover for services rendered e The patient responsibility percentage if applicable The network tabs located at the top will allow you to navigate between the different levels of coverage based on participation and plan type In Network No Out of Network Referral ype of Service Descriptio
3. Forthe medical product 1f the password has not been changed within 90 days you will need to contact the ODS web administrator to have the account restored and a temporary password assigned A reminder notification will automatically appear if you log in 7 days before the 90 day period is completed as a helpful reminder What if you forget or lose the password If you forget or lose your password simply click on the forgot password link on the Sign on screen You will be prompted to answer the challenge question you selected when registering Workstation Location The workstation screen through which the ODS Benefit Tracker 1s viewed should be located in an area where the information cannot be seen by unauthorized individuals Logging off of Benefit Tracker when it is not in use Since personal information 1s to be kept as secure as possible we ask that you log off of Benefit Tracker when it is not in use To log off simply hit the log off link located at the top of each screen If Benefit Tracker has not been queried for a period of 15 minutes the application will automatically log you out You will need to login to the application to begin using it again Getting Started with Benefit Tracker Medical Product Registration To begin using Benefit Tracker for medical vision and pharmacy plans you will need to 1 Open your web browser by double clicking on the icon 2 Type in the address or location of the Moda Health medical
4. If for some reason you need to see benefit levels for an earlier date simply change the date parameters and select the Go button to do so Subscriber ID Shows in the upper left hand corner of the results screen Subscriber Name Displays the name of the subscriber on the results Group Number and Group Name Group information will display in the upper right hand corner of the results screen Insurance Type Clarifies the nature of the plan and is located in the upper right hand corner of the patient information Knowing the plan type will assist the provider in determining whether or not referrals are needed or if the patient 1s able to see a provider of their choice medical only or for dental whether it is a Premier Traditional or Preferred Provider Option plan Network Appears in a light green color below the subscriber name on the near left hand side It clarifies the network of physicians facilities and hospitals that are associated with the patient s plan Patient Information Bar Provides information such as the gender relationship to the subscriber birth date and active status Plan Begin Plan end This marker will clarify the plan effective date and 1f terminated the estimated or confirmed end date of coverage Plan end date information will appear in red if populated COB Begin COB end If ODS is aware of other primary insurance these fields will display the effective and end dates of other coverage The dates will be blan
5. benefit percentage levels Please make sure you are certain of your provider status prior to quoting benefits to a patient for a Dental Preferred Provider Option plan PPO In Plan Network Out ot Plan benefits Individual Remaining Family Family Remaining Deductible 01 50 00 50 00 150 00 150 00 Annual Limit 41 1 500 00 1 500 00 PEA MA Lifetime Limit 115 1 000 00 1 000 00 RA MA Serice Period Calendar In Plan Network Henetit Incentive Annual Lifetime service Type Percent Indicator Deductible Limit Limit Diagnostic Services 100 Mo 1 500 00 41 Preventive Services 100 Mo 1 500 00 41 Restorative Services HU Yes 50 00 C1 1 500 00 41 Endodontic Services go St Yes 50 00 C1 1 500 00 41 Periodontal Services 80 Yes 50 00 01 1 500 00 A Analgesia 0 1 500 00 A1 Oral Surgery 20 Yes 50 00 001 1 500 00 41 Crows 50 Mo 50 00 C1 1 500 00 41 Fixed Prosthetics DU D Mo 50 00 04 1 500 00 41 Removable Prosthetics SO Mo 50 00 C1 1 500 00 41 Repairs To Dentures 50 Mo 50 00 C1 1 500 00 41 Orthodontic Services 50 Mo 0 00 null 1 000 00 L1 20 PPO out of network In Plan Network Out of Plan benefits Individual Remaining Family Family Remaining 50 00 50 00 150 00 150 00 Annual Limit 81 1 500 00 1 500 00 PA MA Lifetime Limit L1 1 000 00 1 000 00 BA BA Semice Period Calendar Out of Plan benefits Benefit Incentive Annual Lifetime service Type Percent indicator De
6. ya Tracker Enterprise Benefit Tracker User Manual 2014 moda HEALTH www modahealth com Revised 10 13 14 Table Of Contents IER NET e erresen eere ota eee ee A EIA A ee eo Benefit Tracker Overview 0 0 0 0 HE 8 Security and Password Protection 0 0 E Page 8 EE ele ee Page 4 Getting Started with Benefit Iracker H ape 5 Medical Product ReglStrati n Au er a a ed Moses RASO D Dental Product Registration iii A A E S Page 5 Medical Product Sion Mon a eared A A A ee ee eee ee 6 Beuerteelung Page 7 Dental Ge ee Ee ini calla Page 8 Forgot User name Pass e E lalala aisladas Page 8 laa GP ASS WON EE Page 11 Patient E a to IS MOS A eee oS os OS den a ape LZ Plan Mie ipility DISPARA ai Page 13 ET e EE EE Page 15 Medical Benefits DISPO Page 15 Plan Maximums and Wee TE Page 15 Additional Flan torna ad is Page 16 Benet Details iaa Page 17 Dental Benents eebe Page 19 Dental PPO Elte ee a va see tas Page 20 INGONTIVS Llista Page 21 Group LIMA ONS AS a sacas Page 21 Clamms DIS PAG tes ts ia Page 22 Selen D ME Page 23 Frequently Asked Ouestions cece cece cece eenceeeeeeeeeecceeeeeeeenseeeeeeeeseeeeeceeeseseesengees Page 24 Contact Us AAA San ee O ei aa es Page 25 Introduction Enterprise Benefit Tracker is an online tool designed specifically for providers to look up patient eligibility benefit and claims information This service gives doctors the most up to date information directly from ODS Health Plan
7. field 1f you need to know if an authorization is requested for these services Benefit Details Under the Benefit Information section there is a select category drop down box that will assist you in determining details of benefits covered your patient s plan The default search will be noted at the In Network level To change this simply select the out of network radio button before hitting Go Select for benefit details PCP Service In Network With Referral In Network No Referral Out of Network Selecta category There are many categories to choose from select for benefit details PCP Serice In Network With Referral In Network No Referral out of Network Selecta category Selecta category Benefit Period Acupuncture Chiropractic amp Naturopath Pre existing Months Ambulance Home Health Hospice Nursing Dependent Stop Age Hospital Student Stop Age Infertility Family Planning Domestic Partner Maternity Mental Health amp Chemical Dependency Referrals S yr 243 5105 Authorizations EE 243 5105 i Customer Service Rehabilitation Outpatient EE Mental Health and Preventve Care lealth and Chemical Chemical Dependency Thy 1 9391 RX Diagnostic amp Imaging Services Lab amp X ray PSenption drugs Emergency amp Urgent Care ded with the medical plan Transplant amp Donor E Pre existing months note
8. if I don t know the subscriber s ID number A Due to HIPAA requirements and federal mandates that regulate the privacy of insurance information you must have the subscriber s ID number to be able to access any patient information Q Why do I get an error message about JavaScript when I try to access Benefit Tracker 27 A You may not have JavaScript enabled Check your Internet preferences which are found under Internet Options Security in Microsoft Explorer Q Why am I only able to see one person at a time as opposed to the entire family A Due to HIPAA The Health Insurance Portability and Accountability Act we have limited the information shown on Benefit Tracker to be patient specific Without the patient s name and subscriber id number you will not be able to access any information moda How to Reach Moda Health Enterprise Benefit Tracker Customer Service Moda Health Enterprise Benefit Tracker Customer Service can be reached Monday Friday between the hours of 8 00 a m and 4 30 p m Medical Benefit Tracker 503 265 5616 or toll free at 877 277 7270 Dental Benefit Tracker 503 417 3197 Option 1 or toll free at 877 337 0651 Email ebt modahealth com 28
9. is displayed Phone numbers are also available in case you need to contact ODS Health Plans directly Lifetime Limit This marker will provide the lifetime limit maximum available for the policy in question Remaining amounts are not displayed in EBT Footnotes There may be footnotes that apply for particular groups covering specific contractual obligations such as out of pocket maximums plan deductibles or specific benefit limitations If applicable match the corresponding number to get more information regarding the subject in question Additional Plan Information Benefit Period Calendar Pre existing Months 0 Dependent Stop Age 1 Student Stop Age 23 Domestic Partner Domestic partner benefits are not available Referrals Phone 503 243 4496 or 1 800 258 2037 Fax 503 243 5105 Authorizations Phone 503 243 4496 or 1 600 258 2037 Fax 503 243 5105 Customer Service Phone 503 265 2966 or 1 888 873 1383 Fax 503 948 5577 Mental Health and ODS Behavioral Health ODSBH is the ODS Mental Health and Chemical Chemical Dependency Dependency Program Coordinator Phone 1 600 799 9391 RA No coverage available on this plan for outpatient prescription drugs Members receive a free pharmacy discount card included with the medical plan Upon request from the member E Pre existing months note No pre existing exclusions except a 12 month waiting period for transplants Please contact customer service for more details concerning t
10. is useful for both your office records and your patient s records If a copy of your PDR or your patients EOB is lost simply print this screen and keep in their file You can also provide your patient a copy 1f needed Date This field displays when a check was issued from ODS for payment on the highlighted claim Frequently Asked Questions Q Why does it say either my user ID or password is incorrect if 1 know I m entering it correctly A Make sure you are not typing in all capitals when attempting to log in Benefit Tracker is case sensitive and will not recognize your user ID or password if the case is not correct Q Why won t it accept the new password ve chosen A Passwords must be a combination of both numbers and letters no special symbols For example troy56 or 401khelp Benefit Tracker also requires your password be at least six digits long and no more than 12 digits long The system will not allow you to reuse a previous password Q I changed my password successfully but the next time I logged in it said my new password was incorrect Why A You may have a Windows preference that automatically stores your passwords for you When you login for the first time after changing your password clear the asterisks that are in the password field type in your new password and click Login If you get a pop up box that asks if you want to change the password stored in Windows to your new entry choose yes Q What
11. web page The URL or web address is https www modahealth com medical 3 On the Moda Health Welcome Medical Providers page select the Request an account link Located on the lower right hand side of the page https www modahealth com medical mbt shtml 4 On the screen that appears you will see two steps available for registration Site Administrator Accounts The initial or primary account will be designated as the site administrator and will require a completed electronic services agreement under step 1 as well as a user name registration under step 2 Once the signature page on the service agreement is faxed back to Moda we will process the request within 72 business hours and send a confirmation e mail letting you know when the account has been allowed as well as some administrator features of your profile The fax number to return the service agreement is located at the very bottom of the link provided When the primary account has been created each additional user need only complete step 2 and an automatic e mail will be forwarded to the site administrator to activate User Accounts and the Benefit Tracker Registration Form Once a site administrator account is set up for your office with a designated individual in charge of monitoring users at the site each additional user need only complete step 2 Please note that the system will not recognize special characters in the user name and should not be used Once the registration form
12. acility When you select the forgot password link the system will request that you verify the profile type loaded in the system Select the first option Tu ser Name il Y business Tax ID Provider First Name Provider Last Name icense ID Proceed to Step 2 Simply verify the information on the profile to continue 10 Note The provider first name and last name will need to match what is loaded in ODS records If the system is not recognizing the provider please contact us at the phone number at the end of the manual for assistance License ID numbers may only include the numbers of the license The system does not recognize alphabetical prefixes such as the letter D when verifying your information Forgot Password Step 2 of 3 Your User name has been verified Below is the Challenge Question you need to answer to proceed to Step 3 Chalenge Question City of birthplace Challenge Answer i Proceed to Step 3 Once the above information is verified the system will request that you answer the security question created when the profile was originated Forgot Password Step 3 of 3 Your challenge question has been validated Please enter your new password New Password Confirm New Password Password must be at least 6 characters including two numeric characters Example mypass23 Submit New Password Finally the system will allow you to change the password to a new designated password that fo
13. ame and Password to access our system If you have not been issued a User Mame and Passyrord please register here you currently use Internet Explorer 6 0 and experience problems while using this website you may need to download a software update from Microsot Learn more User Mame Password case sensitive Forgot your User Mame Request d here Forgot your Password Request t here Mev Users register here The system has several self help tools available to assist you with your login should they be needed Forgot User Name To provide your user name to you simply verify the information on the account as it appears below Forgot User Name Step 1 of 4 lf you have forgotten your User Name it can be requested and emailed to you Enter your user information below to initiate the process Business Tax ID User First Name User Last Name Provider First Name Provider Last Name License State Proceed to Step 2 Cancel lf you are having difficulty recovering your User Name click here for customer service contact information Note a The system recognizes the tax id number only as a full series of numbers and will not recognize hyphens or dashes in the tax id b The provider first name and last name fields must match the way the name is indicated in our records If the system does not recognize the name configuration you provide please contact us at our phone number at the end of this manual for a
14. bility to check certain procedures against member s history Here are a few common examples Example 1 Services are currently available Sy Benefit Tracker Procedure utilization Eligibility and Benefits Procedure Utilization Group Limitations Claims EOBs Member Handbook Family EBT Home Change Passwor Subscriber ID D167 Insurance Type Dental Preferred Subscriber Name Group Number 10001767 Group Name US Bank Minimum Age 0 Description Amal 3 Surfaces Amalgam three surfaces primary or permanent Maximum Age N A Service Type Restorative Services Benefit currently available Yes Benefit next available Procedure Utilization Proc Code D2160 Beginning Tooth 08 Ending Tooth 08 Check Utilization 29 Example 2 Service is not available due to frequency limit Description Crown Gold Crown full cast high noble metal Minimum Age 0 Maximum Age N A Service Type Crown Denial Reason Limited to Once Each 7 Years Benefit currently available No Benefit next available 06 30 2018 Procedure Utilization Proc Code D2 790 Beginning Tooth 2 Ending Tooth 2 Example 3 Please call customer service e Information for this CDT code for this member is not currently available online Please contact Dental Customer Service at 1 888 217 2365 with questions Minimum Age 0 Description Maximum Age NA Service Type Denial Reason Benefit currently available
15. c Services FO Yes 1 500 00 4 1 Periodontic services FO Yes 41 500 00 41 Analgesia O 1 500 00 41 Oral Surgery TO Yes 1 500 00 A1 Crowns TU Yes 41 500 00 Ai Fixed Prosthetics DU Mo 1 500 00 41 Removable Prosthetics 50 Mo 41 500 00 Ai Repairs To Dentures DU Mo 41 500 00 41 Orthodontic services BO Yo Mo 1 000 00 L1 All incentive plans will display beginning incentive only Please call for current incentive Dependent Stop Age 145 student Stop Age ER sealant stop Age g Fluoride Stop Age g Onthodontia Eligibility Family incentive Tiers 20080 90 100 All eligibilitybenetits claims status information is confidential This is not an approval of treatment or quarantee of payment 19 e Plan Maximum and Deductibles information can be found in the middle of the screen This category will display the deductible and maximums are for the benefit year in question if the deductible has been satisfied and how much of the maximum is remaining for the time period in question e Benefit Information will display the date range in which benefits are available and when the benefit renewal date 1s in the following plan year The plan benefits are listed below this and include service type benefit percentages whether or not an incentive and or deductible will apply and to which maximum the services apply Dental PPO Plans For a member on a PPO Plan you will have the option of viewing the in network or out of network
16. d Minor 4djustment To Occlusion eriodontic Surgery 1 500 00 A1 1 500 00 41 51 500 00 A1 1 500 00 41 AAA 1 500 00 41 y EE Treatment 1 500 00 471 A T0 Yes 1 500 00 41 Simple Extractions 1 500 00 A1 TMJ Services IIA Fixed Prosthetics 1 500 00 A7 51 500 00 A1 Removable Prosthetics DN y 1 500 00 41 d 1 500 00 41 Orthodontic Services The members beginning incentive level is displayed 1 500 00 41 1 500 00 41 Please call Customer Service for current incentive Stop Ages Dependents students sealants and fluoride information can be found at the bottom of the Eligibility and Benefits page You will also see Orthodontic Eligibility and Incentive Tiers If your patient 1s on an incentive plan the different incentive tiers will be listed A constant plan will show N A Dependent Stop Age 26 Student Stop Age 26 Sealant Stop Age qu Fluoride Stop Age Wo Onrthodontia Eligibility 99 22 Common Preventive Services Box Effective 11 20 2011 EBT has added a box that indicates whether a member is eligible for common preventive services If the member is eligible the service will indicate Yes If not eligible the box will indicate No but will display the date that the member is eligible service Type Benefit currently available Benefit next available 01 01 2012 01 01 2012 Bitewing x rays FMX or panoramic x ray Procedure Utilization EBT now offers the a
17. ductible Limit Lirnit Diagnostic Misc Services g0 Mo 1 500 00 41 Complete xray Series g0 Mo 1 500 00 41 Exam Services 90 Ho 1 500 00 A1 Bitewing HU Mo 1 500 00 4 1 Fluoride Services g0 Mo 41 500 00 Ai Incentive Level Plans Benefit Incentive Service Type Percent Indicator 0 100 1 500 00 A1 Complete X ray Series 100 1 500 00 47 Bitewing X rays 100 Ver 1 500 00 41 1 500 00 A1 Periapical X rays 100 1 500 00 41 1 500 00 41 Prophylaxis Services 1 500 00 A1 1 500 00 A1 1 500 00 A1 1 500 00 A1 1 500 00 A1 Occlusal Guard 0 IA Minor Adjustment To Occlusion 0 a 100 Yes 1 500 00 A1 100 Yes 1 500 00 A1 0 OO a Oa 100 Yes 100 e 1 500 00 A1 50 1 500 00 A1 50 l 1 500 00 A1 50 1 500 00 At 50 1 500 00 A1 50 1 500 00 A1 50 1 500 00 A1 50 1 500 00 L1 Procedure Utilization Dependent Stop Age 23 Student Stop Age 23 Sealant Stop Age 17 Fluoride Stop Age NA Orthodontia Eligibility MA Incentive Tiers 70 80 90 100 Check Utilization EBT now displays the current incentive level for each member If your patient is on an incentive plan the different incentive tiers will be listed See above example There are some plans where you will need to contact customer service to determine the correct incentive levels In this instance the following message will display General Anesthesia Restorative Services Endodontic Services Occlusal Guar
18. ffice Just as we take great care to safeguard our member information in its delivery to you 1t is equally important that your office take steps to safeguard that information Your responsibilities include the following 1 Using your own User ID and password 2 Using and maintaining your own password protection and confidentiality 3 Ensuring that the workstation monitor is not in view of unauthorized personnel 4 Ensuring that you have signed off of the application when it is not in use Each of these is explained in more detail in this manual Passwords Establishing a Password Passwords are an integral part of your responsibility in maintaining security and privacy The following guidelines are to be used in selecting a password e Passwords must be at least six characters in length e Passwords must include a minimum of 2 numbers e No special characters are allowed i e e May include upper and lower case letters e Should not be an ascending or descending series of numbers of letters 1 e 654321 abcdef It is important that the passwords not be obvious to anyone else or easily guessed For instance the passwords should not be e Your first name or the name of a family member e Your birth date e Repeating letters or numbers 1 e 111aaa abc123 Requirements for changing a password Passwords must be changed 1 Ifa staff member with known access to the password system leaves employment with the office 2
19. has been submitted an automatic e mail will be sent to your site administrator They will then set your permission levels and activate your account Dental Product Registration To begin using Benefit Tracker for dental plans you will need to 1 Open your web browser by double clicking on the icon 2 Type in the address or location of the Moda Health dental web page The URL or web address 1s https www modahealth com dental 3 On the Moda Health Welcome Dental Providers page click on the Create an Account link located on the lower right hand corner of the page https www modahealth com dental benefittracker registration info shtml You will then be guided in completing your online registration with Delta Helpful Registration Tips a The system recognizes the tax id number only as a full series of numbers and will not recognize hyphens or dashes in the tax id At this time NPI numbers are not being utilized for registration b The provider first name and last name fields must match the way the name is indicated in our records If the system does not recognize the name configuration you provide please contact us at our phone number at the end of this manual for assistance c License ID numbers may only include the numbers of the license The system does not recognize alphabetical prefixes such as the letter D when completing your form When your registration at Delta Dental is complete simply select the log off link located in
20. ifetime limit note Restoration Benefit When a member receives benefit from this plan during the year the amount paid up to 50 000 will automatically be restored the following January 1st to the available lifetime maximum benefit Office Co pay Reflects the copayment figure for office visits only Additional co payment information may apply Deductible Individual Determines what your patient s deductible limit is The individual remaining amount shows how much in costs the patient needs to meet before services would be covered at the contracted rate Deductible Family Reflects the patient s family deductible limit is The remaining amount shows how much the family needs to meet before the family s services would be covered at the contracted rate Out of Pocket Individual Displays the out of pocket maximum for the member s current benefit year The individual remaining amount shows the amount the member needs to meet before they are no longer responsible for co payments or coinsurance amounts for the remainder of their current benefit year Out of Pocket Family Displays the out of pocket family maximum for the subscriber plan s current benefit year The family remaining amount displays how much the family as a whole needs 15 to meet before they are no longer responsible for co payments or coinsurance amounts for the remainder of the current benefit year Just below this field additional benefit information
21. isplay as a range of dates i e From 08 16 09 To 08 26 09 Once a highlighted claim number has been selected you may then view the detail of how the claim was processed Selected Claims Detail Mon Provider Remaining Benefit Tatal Covered Disg Covered Copa Ft Total Pd To Dates Charges Charges Deduct Disallow charges Coins Resp Benefit Prov Comments 10 3 08 Other Procedure Code 93224 270 34 0 00 5100 00 7 09 163 25 32 65 44 30 4430 PDC 10 8 03 Office Visit Code 99214 168 66 0 00 0 00 5 08 163 60 15 00 27 57 27 57 PDC Totals 439 22 0 00 100 00 12 17 327 05 347 65 30 00 187 71 87 Check Claim Check Payee Amount Date EENEG Check 1701001 Doctor Who 503 28 11 21 2008 Yes Claim Memo Reason Code PDC Provider discount has been applied Patient Account Medical Claims Display Only This number is provided from Box 26 of your billed HCFA form or Box 3 from a billed UB 92 form and appears in the upper right hand corner of the screen 26 Check Number This field provides the check number that was issued from ODS Disallowed Amount This field will display the difference between the total charges and the allowable amount per treatment code Reason Code This field will provide explanations on benefit reductions or limitations Claim Memo Manual notes from claim adjusters or customer service that explains why a claim paid or did not pay would display here Printable This screen
22. k if ODS is primary Check Eligibility for another date This feature allows you to check your patient s eligibility and benefits for a date other than the current day You will be able to see if the patient in question had active coverage on a specific date within the previous 18 months 14 Member Handbook From any screen in Benefit Tracker you will be able to link to your patient s member handbook if it is available Some plans may print their own handbooks which ODS will not have access to Simply click on the Member Handbook link located at the top of your screen to see if the member handbook 1s available Benefits Display Medical Benefits Display Just below the Patient Information Bar the patient plan maximum and deductible information will appear You may select an in network or out of network status simply by clicking on the appropriate link Plan Maximums and Deductibles In Network Cut of Network Office Copay 10 00 Individual Family Individual Remaining Family Remaining Deductible 0 00 0 00 0 00 0 00 Out of p ocket 1 000 00 921 20 ee aag Lifetime Limit 2 000 000 00 SE Se SR 1 Outof Pocket note After the member has met the annual per person out of pocket maximum the plan will pay 100 of covered services The following do not accrue toward the out of pocket maximum Incurred charges that exceed amounts allowed under this plan charges of an alternative care provider and disallowed charges 2 L
23. llows the appropriate password guidelines Change Password There may be occasions where an office may like to change their existing password like in cases where staffing has changed and an office wishes to maintain security for a provider profile In these cases a user may use the change password function on the main Delta Dental site to have this done To change the password simply select the click here to change your password link at the top of the main profile screen at www deltadental com in the upper left hand corner after logging in to your account 11 Patient Search Once the user ID and password have been verified a Subscriber Patient Search screen will appear Please note that HIPAA requires a user to request information on each specific individual As such three distinct fields will be used in order for member policy information to display 1 First Name 2 Last Name 3 Subscriber Id EBT Home Change Password LogOff Sy ce Tracker Please fill in required fields to find a patient Search Help MBT Manual Provider Manual Patient Last Name First Name Subscriber ID no dashes Required field items displayed in green are not part of the HIPAA standard Search Help MBT Manual Provider Manual Physicians Home Contact Us Privacy Statement Terms and Conditions We welcome your comments on how to improve our site Note Information will need to be entered as it a
24. n Anesthesia Anesthesia Facility Refractive Surgery Surgeon Surgery Outpatient Ophthalmologist Second Opinion Office surgical Supplies Outpatient There may be additional footnotes that apply on benefits displayed These footnotes if they appear will provide detailed instructions that will be useful in inquiring on specific coverage allowances and possible unique plan limitations 18 Dental Benefits Display Below the eligibility portion of the member information dental benefit information will display JANE E SMITH Eligibility and Benefits Eligibility and Benefits Group Limitations Claims Member Handbook Subscriber ID 122456759 Insurance Type Commercial Delta Premier Subscriber Name JOHN SMITH Plan Number 1234 56 Plan Name COMPANY ABC Check eligibility for another date use mordddaaa 0270972004 Go Gender Relationship Birth Cate Plan Begin Plan End Status COB Begin COB End Female Spouse 12 041 954 01 01 1986 LE Active o7101 200 12 31 2050 In Plan Network Individual Remaining Family Family Remaining Annual Limit 81 1 500 00 1 500 00 MA Hi Lifetime Limit L173 1 000 00 1 000 00 RA Hi Service From To Dates 10 01 2003 09 30 2004 In Plan Network Benefit Incentive Annual Lifetime Service Type Percent indicator Deductible Limit Limit Diagnostic services FO Yes 41 500 00 Ai Preventive Services TU Yes 1 500 00 41 Restorative Services FO Yes 41 500 00 Ai Endodonti
25. nd office tax IDF below Your User ID will be e mailed to you within the next business day First Hame Last Name Office Tax IDF TIN Once the contact information has been provided select the submit button and the system will send you an e mail to the e mail address on your profile with the user information Forgot Password Forgot your Password If you ve forgotten your password please fill in the fields below Your password will be displayed on the next page provided all information is entered correctly User ID Mothers Maiden Name Office Tax ID TIN no dash Once the requested information has been provided select the login button and the system will automatically generate a temporary password for use Dental Product Sign In Once your registration has been completed simply use your newly assigned user name and password to begin your patient search Simply login at www modahealth com dental You will see the Benefit Tracker logo on the left hand side Double Click this to enter the login screen Benefit Tracker Note If you try to log in more than three times with an incorrect User ID or password your account will automatically lock you out Fri Sept 16 2009 lt DELTA DENTAL Dentist Sign In If you are a dentist you now have the ability to sign on to our secure on line system and check patient benefits eligibility and claims information To do so please enter your User M
26. pe group number and group name Additional information appears as follows Sy Benefit Tracker E Mary Dodson Medical Benefits Medical Benefits Vision Benefits Rx Benefits Claims Referrals POP History Member Handbook Subscriber ID 00000000 Insurance Type HMO POS Subscriber Name Matt Dodson Group Number 99999999 Group Name Mars Landing Network ODS Plus Network with ODS Behavioral Health Check eligibility for another date use mm dd yy 09 21 2009 Gender Relationship BirhDate PlanBegin PlanEnd Status COB Begin End Female Spouse 04 01 1963 06 01 2006 I Active 13 Navigation Links Appear at the very top right hand side of the benefit tracker and provide functions helpful to your use of the program A few examples include e Patient Search Allows you to begin searching benefits under a new individual e Physician Search Transports the user to an online provider directory where they can search for providers or facilities that are in network for the displayed member e Log off Gives you the ability to log off of the program manually when stepping away from your station to maintain patient information security e Contact Us Located at the bottom of the eligibility and benefits screen and provides valuable contact information to different ODS departments should they be needed Check Eligibility for Another Date As a default eligibility and benefits will always display the current date
27. ppears on the card If the card is not available and no results are displaying please contact the Moda Health Benefit Administrator phone number at the end of this manual In addition several of our groups require the derived generic id number and will not cross reference with social security numbers If at all possible please obtain this from your patient for the best results You may come across patients whose name and subscriber id number match i e father and son with the same name If this occurs you will be prompted to enter a date of birth Wve matches Were found for tls Input Enter the Bith Date rrtrwvcOchkdaa format for fhe person WOU want Patient Last Mame MUDO First Mame HARRY Birth Date 12 Patient Search Plan List If the patient has more than one active plan with Moda you will be given an option of choosing which plan benefits to view This screen will also show the name and effective date of each plan so you can determine which to bill as primary if applicable Patient Search Plan Lists Make selection fror following list aplert Group Hame From Date To Date OG PUBLIC EMPLOYEES BENEFIT BRO 01012002 12412050 O CLACKAMAS COUNTY 030501 1213112050 Continue Hens displayed in green are not a pan ofthe MPAA standard Plan Eligibility Display At the top of the Eligibility and Benefits page you will see the patient s name and plan information including insurance ty
28. ransplants Wanuscript note One vision exam for ages 18 and younger is allowed every 24 months under the Medical Plan For members enrolled on the Vision Plan one vision exam is allowed every 12 months for all ages Vision exams for children 18 and younger are processed under the Medical Plan first The vision exam copay matches he office visit copay which is shown above Pre existing Conditions Some plans have pre existing conditions set forth in the policy This field will advise you what those conditions are and what the waiting period is if applicable Departmental Phone Numbers There are dedicated provider phone fax numbers for the appropriate ODS internal departments that apply to the plan displayed These numbers can change in accordance to the plan benefits For example e Referrals If the plan requires referrals the phone number will be listed in this field If the plan does not require referrals the numbers will be replaced with a message that states Referrals Not Required On This Plan 16 e Authorizations These are handled in the same way as referrals are If the plan requires authorizations the phone number will be listed If the plan does not require authorizations the numbers will be replaced with No Authorizations Required On This Plan e Mental Health Chemical Dependency This field will indicate the appropriate phone number to call in case any mental health services are needed Please check this
29. s The ODS Benefit Tracker application is available 7 days a week from 6 00am to 10 30pm PST Benefit Tracker Overview To begin using Benefit Tracker you will need e An Internet Service Provider or ISP There are many Internet service providers to choose from such as Comcast MSN or Proaxis You can check your local newspaper or phone book for ISPs in your area as well e An Internet browser ODS Benefit Tracker is best viewed using Microsoft Internet Explorer 6 0 or higher When signing up with an ISP they often set up and install a browser for you Refer to your ISP for more information on downloading and installing a browser e Your User ID and Password You will choose your own user id and password when registering at the Delta Dental website for Benefit Tracker Since computer configurations operating systems and browser versions may be different for each user it is difficult to give consistent step by step directions for this process If you run into problems please call Enterprise Benefit Tracker technical services at 503 417 3197 or toll free 1 877 277 7270 for medical and 1 877 337 0651 for dental Security and Password Protection Security Security and confidentiality of member information is very important to Moda We have used advanced technology to provide a secure system for making information available to you We are also very sensitive to only allow access to information that 1s necessary and relevant to your o
30. ssistance c License ID numbers may only include the numbers of the license The system does not recognize alphabetical prefixes such as the letter D when completing your form Once the above information is verified the system will request that you answer the security question created when the profile was originated Forgot User Name Step 2 of 4 Your user information has been verified Below is the Challenge Question you need to answer to proceed to Step 3 Challenge Question Name of favorite pet Challenge Answer Proceed to Step 3 Once the provider information has been verified the system will request confirmation of the e mail address connected to the profile Forgot User Name Step 3 of 4 Your account information has been verified An email address was provided to us when you registered Please verify the email address below to proceed to the next step in the Forgot User Name process Your Email Address i Finally once the e mail address has been confirmed the user name will be e mailed to the authorized individual Forgot User Name Step 4 of 4 Your email address has been verified To proceed with having your User Name emailed to dental odscompanies com simply click Continue If you would like to specify a different ema Continue Forgot Password Tell Us More lam either a Dentist or am associated with a Dentist lama Subscriber and have coverage with Delta Dental lama DettaCare F
31. the page to view Note Benefit Tracker will only display claims processed with your tax id number in the previous 18 to 21 months We provide this information for the convenience of your office as well as the privacy of the patient Glaim Number Semice Type of Semice Charge Copay R Provider Status 8 Dates Service Code Amount Deductible Coins Paid 0652270894 00 Who Paid 72 73 08 11 6108 Preventive 9939525 295 00 0 00 20 00 64 12 Doctor Exam GYN Who Paid 12 13 08 11 6 08 Preventive 8150 45 00 S000 000 14 05 Doctor Lab Pap Test Who Paid 12 13 08 11 6 08 Preventive 9900090 15 00 5000 000 0 00 Doctor Lab Pap Test 25 Claim Number This field will display claim numbers assigned by Moda Any claim that has a paid status will provide a link from the claim number to a detailed report of how the claim was processed To see the Claim Detail click on the linkable number Status of Claims e Paid The claim has been processed and payment or denial notification has been sent e In Process The claim is on hold It might need review or more information from the provider or patient e Pay Next Disbursement Moda Health pays claims within 1 week of being released except holidays It will remain in this status until the payment check is cut It will then change to a paid status e Service Dates In most cases the date of services will encompass one business day Claims billed with more than one service date will d
32. the upper right hand corner To continue close your browser window open a new browser window and return to the ODS website to login to Dental Benefit Tracker to begin your search Signing In Medical Product Sign In Once your registration has been completed simply use your newly assigned user name and password to begin your patient search Simply login at www modahealth com medical You will see the Benefit Tracker logo on the left hand side Double Click this to enter the login screen Benefit Tracker The below login screen will appear Welcome to the ODS Enterprise Benefit Tracker UserID You can find up to the minute medical eligibility benefits claims and referral information online 7 days a week from 6 A M to 10 30 P M PST Password Please contact the Benefit Tracker Administrator if you re having trouble logging in or would like information about Benefit Tracker Please be sure to include your tax id number and user name if already registered Forgot your User ID or password Note If you try to log in more than three times with an incorrect User ID or password your account will automatically lock you out and the Benefit Tracker Administrator will need to be contacted in order to restore your profile The system has several self help tools available to assist you with your login should they be needed Forgot User ID Forgot your User ID If youve forgotten your User ID please fill in your name a
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