Oregon Health Plan (Medicaid), Medicare and Commercial Members
2016 Provider Workshop Presented by Moda Health Agenda • Moda Networks • OEBB & PEBB Plan Changes • Credentialing • Primary Care Support • Prior Authorizations updates • Ensuring Accurate Claims • Risk Adjustment • Contacting Moda Health Moda Networks Total membership 266,403 42,269 46,763 Commercial Medicare Medicaid - EOCCO Northern Coast membership 10,165 3,971 Commercial Medicare Southern Coast membership 8,191 1,328 Commercial Medicare Southern Valley membership 22,478 4,527 Commercial Medicare Eastern Oregon membership 46,763 19,108 3,745 Commercial Medicare Medicaid - EOCCO Portland Metro membership 92,245 9,878 Commercial Medicare The Gorge membership 4,194 827 Commercial Medicare Central Oregon membership 21,943 2,660 Commercial Medicare Willamette Valley membership 37,891 4,649 Commercial Medicare West Central Valley membership 32,935 6,776 Commercial Medicare 2017 Network overview Affinity (Individual plans) Medicare Advantage Beacon (Individual plans) EOCCO (Medicaid) Connexus (Large and small group employer plans) Summit Synergy (Large and small group (Large and small group employer plans) employer plans) 2017 Individual Network lineup Clackamas, Clatsop, Columbia, Coos, Curry, Beacon Hood River, Jackson, Josephine, Marion, Select Western Oregon Multnomah, Polk, Wasco, counties Washington and Yamhill counties Affinity Baker, Grant, Gilliam, Harney, Lake, Malheur, Eastern Oregon Morrow, Sherman, counties Umatilla, Union, Wallowa and Wheeler counties Beacon Network Effective January 1, 2017 What is different? • Smaller geography • Clinically integrated network, which includes nine health system partners and their referring providers • Simplified plan design options (1 bronze, 3 silver and 3 gold) • PCP selection is required Beacon Network 1. Adventist Health 4 2. Asante 6 3. Bay Area Hospital 8 1 5 4.
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