Provider network design criteria

In general, provider network refers to physicians, dentists, specialists and facilities that we've contracted with to provide benefits to individuals and groups covered under all Moda Health and Delta Dental plans. During the process of choosing and maintaining the provider networks available to our Oregon and Alaska commercial and marketplace membership, we consider a variety of criteria. The following outlines some of what goes into our network design process and applies to all service areas and product lines unless otherwise noted.

Provider types

All Moda provider networks available to our members are inclusive of the following basic provider types:

Primary care provider (PCP)

A medical provider offering routine medical services to help keep patients healthy, such as screenings, physicals, women's annual exams, well-baby care and immunizations. Moda Health medical plans cover 100 percent of most preventive care.


A medical provider specializing in a specific type of health condition or care. Specialists include cardiologists, dermatologists, naturopaths, oncologists, urologists and many others.


Any location where medicine is practiced regularly. Medical facilities range from small clinics and doctors’ offices to urgent care centers and large hospitals with emergency rooms and trauma centers.

Preferred provider

A provider contracted with a network. By choosing a preferred provider, your out-of-pocket expenses will be less than if you choose a provider outside the network. Providers in your network have agreed to accept your health plan and provide services at prearranged rates.

Geographic distribution

Moda Health maintains and monitors standards for availability of participating primary care, high-volume specialty care, and high-volume behavioral healthcare practitioners and facilities to ensure that service and coverage for members residing in our service areas are adequate. This involves analyzing both provider-to-member ratios and geographic distribution by county in each of our service areas.

Cultural needs and preferences

Moda Health maintains and monitors standards for availability of participating providers whose cultural and ethnic backgrounds, and language capabilities, meet the needs of our membership.

Provider selection criteria

Moda Health ensures that only high-quality providers are included in our networks through our credentialing and recredentialing processes.

Prior to allowing network participation, we verify a practitioner's credentials, including a valid license to practice, education and training, malpractice history, and work history within the timeframes specified by the standards and guidelines of the National Committee for Quality Assurance (NCQA), Centers for Medicare & Medicaid Services (CMS), and state insurance divisions. Information provided within the application will be verified through several entities, including the Office of Inspector General, the National Practitioner Data Bank, and the appropriate licensing and educational entities.

Moda requires recredentialing of all practitioners and organizational providers at least every three years. We perform ongoing monitoring of our practitioners between credentialing and recredentialing cycles. This is to ensure that quality of care and safety concerns are addressed in a timely manner and that the practitioner is compliant with all of our standards. We document monitoring activities and complete a thorough and fair investigation.

We also monitor and analyze member feedback relating to network access via our CAHPS and direct member survey processes. This helps give focus to our network improvement efforts. Our select Synergy and Summit provider networks, which cover specific regions of Oregon, use cost and quality metrics as factors that influence inclusion in these networks. More specifically, results against quality measures that are selected on an annual basis are evaluated and a quality feedback mechanism is in place for those not meeting benchmarks.

Beyond these exceptions, Moda does not currently use objective cost, quality, or member experience metrics as part of our network development strategy.


ID number

Look on your member ID card for your ID number.

Moda id card

Contact us if you donÂ’t have your member ID card.

You may also log in to your myModa account to see only providers in your network.

Specialties defined
Acupuncturist Acupuncture is the practice of inserting needles into the body to reduce pain or induce anesthesia. The practice is based on ancient Chinese medicine, and has been adapted to western medicine.
Addictionology The branch of medicine concerned with the study, prevention and treatment of addictive diseases and the physiological and psychological disorders associated with substance dependence. Psychiatrists and psychologists are the most common clinical practitioners associated with this practice, although Neurologists and Anesthesiologists also practice this form of medicine.
Allergy An allergist/immunologist is a physician trained in the prevention, diagnosis, and treatment of immune system problems such as allergies, asthma, inherited immunodeficiency diseases, autoimmune diseases, and even AIDS.
Ambulance A vehicle designed to transport ill or injured patients. It may be used under emergency or nonemergency conditions and is equipped with supplies and personnel to provide patient care en route.
Anesthesiology An anesthesiologist is a doctor who has specialized knowledge and training in anesthesiology and pain relief. Anesthesiology is the practice of medicine dedicated to the relief of pain and total care of the surgical patient before, during, and after surgery. Anesthesiologists can pursue a subspecialty in pain management.
Audiology An audiologist is a licensed health care professional who diagnoses, evaluates, and treats hearing disorders and communication problems. A licensed audiologist has to complete a minimum of a Master's degree in audiology.
Birthing Center A medical facility, often associated with a hospital, that is designed to provide a comfortable, homelike setting during childbirth and that is generally less restrictive than a hospital in its regulations, as in permitting midwifery or allowing family members or friends to attend the delivery.
Cardiothoracic Surgery Cardiac surgery (involving the heart and great vessels) and thoracic surgery (involving the lungs and any other thoracic organ) are separate surgical specialties, except in the USA, where they are frequently grouped together, so that a surgeon training in the cardiothoracic specialty will receive a broader but less specialized experience in both fields.
Cardiology Cardiology is a branch of medicine concerned with the study of the structure, function and diseases of the heart.
Cardiovascular Disease Cardiovascular disease refers to the class of diseases that involve the heart or blood vessels (arteries and veins). While the term technically refers to any disease that affects the cardiovascular system, it is usually used to refer to those related to atherosclerosis (arterial disease).
Chemical Dependency Chemical Dependency (including alcoholism) means a substance-related disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, (DSM-IVTR), except for those related to foods, tobacco, or tobacco products.
Chiropractic Chiropractic Medicine is practiced by a licensed doctor of Chiropractic who diagnoses and treats conditions related to the effects of those conditions on the nervous system and general health. Chiropractic doctors use natural non-invasive treatment approaches, including spinal adjustments, exercise programs, and other forms of therapeutics to help patients eliminate their pain and optimize their health.
Clinical Social Worker A mental health professional trained to provide services to individuals, families and groups.
Dental Hygienist A dental hygienist is a licensed dental professional who specializes in preventive medical care, typically, but not limited to, focusing on techniques in oral hygiene
Denturist/OP Endorsement A denturist, is a member of the oral health care team who provides an oral health examination, takes impressions of the surrounding oral tissues, constructs and delivers removable oral prosthesis (dentures and partial dentures) directly to the patient.
Dermatology Dermatology is the study of investigation, diagnosing, treatment and prevention of skin problems of all kinds. Dermatologist as a profession is a specialty focusing on diverse disorders and diseases of the skin, mucous membrane, hair, nails and a number of sexually transmitted diseases.
Diagnostic Radiology A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
Dietician An expert in food and nutrition.
Durable Medical Equipment Medical equipment used in the course of treatment or home care, including such items as crutches, knee braces, wheelchairs, hospital beds, prostheses, etc
Endocrinology Endocrinology is a branch of medicine dealing with disorders of the endocrine system and its specific secretions called hormones. Although every organ system secretes and responds to hormones (including the brain, lungs, heart, intestine, skin, and the kidney), the clinical specialty of endocrinology focuses primarily on the endocrine organs, meaning the organs whose primary function is hormone secretion. These organs include the pituitary, thyroid, adrenals, ovaries and testes, and pancreas. An endocrinologist is a doctor who specializes in treating disorders of the endocrine system, such as diabetes, hyperthyroidism, and many others.
Endodontist The branch of dentistry that deals with diseases of the tooth root, dental pulp, and surrounding tissue.
Emergency Medicine Provides immediate recognition, evaluation, care, stabilization, and disposition of all ages of patients in response to acute illness and injury.
Family Practice Family practice medicine is the medical specialty which provides continuing, comprehensive health care for the individual and family. It is a specialty that integrates the biological, clinical and behavioral sciences. The scope of family medicine encompasses all ages, both sexes, each organ system and every disease entity.
Gastroenterology Gastroenterology is a branch of medicine concerned with digestive diseases. The practice of gastroenterology concentrates on the diagnosis and treatment of diseases involving the esophagus, stomach, small intestine and large intestine (colon), liver, gallbladder, and pancreas. This medical field is really a subspecialty of Internal Medicine.
General Practice General practice deals with diseases of a general nature for all ages. A general practitioner (GP) or family physician (FP) is a physician who provides primary care. A GP/FP treats acute and chronic illnesses, provides preventive care and health education for all ages and both sexes. Some also care for hospitalized patients, do minor surgery and/or obstetrics.
Genetics Genetics is the branch of biology that deals with heredity, especially the mechanisms of hereditary transmission and the variation of inherited characteristics among similar or related organisms.
Geriatrics Geriatric medicine focuses on health promotion and the prevention and treatment of disease and disability in later life.
Hematology Hematology is the branch of biology, pathology, clinical laboratory medicine, internal medicine, and pediatrics that is concerned with the study of blood, the blood-forming organs, and blood diseases. Hematology includes the study of etiology, diagnosis, treatment, prognosis, and prevention of blood diseases.
Hematology Oncology Diagnosis and treatment of diseases of the blood, spleen and lymph glands.
Home Health Care Service providing nursing, therapy and health related social services in the patient’s home.
Home Infusion Therapy The IV administration of therapeutics–analgesics, antibiotics, chemotherapy, parenteral nutrition–outside of a formal healthcare environment.
Hospice A facility or service that provides care for the terminally ill patient and provides support to the family. The care, primarily for pain control and symptom relief, can be provided in the home or in an inpatient setting.
Infectious Disease Infectious disease medicine is a medical field concerned with diagnosis, treatment, and preventive measures for infectious bacterial and viral diseases of all types. Conditions include AIDS, influenza, hepatitis, and travel-related illnesses.
Internal Medicine Doctors of internal medicine ("internists") are medical specialists who typically focus on adult medicine and have had special study and training focusing on the prevention and treatment of adult diseases.
Laboratory A medical laboratory or clinical laboratory is a laboratory where tests are done on clinical specimens in order to get information about the health of a patient.
Massage Therapist A person who practices therapeutic massage. In many states, massage therapists can be licensed after completing a specified training program. Licensed therapists may practice independently or in a medical setting.
Medical Supplies Disposable health care materials that include ostomy supplies, catheters, oxygen and diabetic supplies.
Midwifery A health care profession where providers give prenatal care to expecting mothers, attend the birth of the infant, and provide postpartum care to the mother and her infant. Practitioners of midwifery are known as midwives.
Naturopathic Naturopathic medicine is the practice of assisting in the health of patients through the application of natural remedies. Most naturopaths consider their care complementary, not supplementary, to the care of a traditional medical professional (MD or physician). Naturopathic medicine (also known as naturopathy) is a school of medical philosophy and practice that seeks to improve health and treat disease chiefly by assisting the body's innate capacity to recover from illness and injury.
Neonatal Intensive Care A unit, usually shortened NICU and also called a newborn intensive care unit, intensive care nursery (ICN), and special care baby unit, is a unit of a hospital specializing in the care of ill or premature newborn infants. The NICU is distinct from a special care nursery (SCN) in providing a high level of intensive care to premature infants while the SCN provides specialized care for infants with less severe medical problems.
Neonatology Neonatology is a subspecialty of pediatrics that consists of the medical care of newborn infants, especially the ill or premature newborn infant. It is a hospital-based specialty, and is usually practiced in neonatal intensive care units (NICUs).
Nephrology Nephrology refers to the field related to medical conditions of the kidney, and a nephrologist treats people with kidney diseases of various types, including those who have lost kidney function entirely and must rely on dialysis or kidney transplant. Nephrology also includes illnesses caused by abnormalities of the body's water and mineral balance, hypertension (high blood pressure) and diabetes related kidney diseases.
Neurology Neurology is a branch of medicine dealing with the nervous system and its disorders. Neurological disorders affect the central nervous system (brain, brainstem and cerebellum), the peripheral nervous system (peripheral nerves, cranial nerves), or the autonomic nervous system (parts of which are located in both central and peripheral nervous system). Physicians specializing in the field of neurology are called neurologists; surgery on the nervous system is performed by physicians called neurosurgeons.
Nurse Practitioner A nurse practitioner (NP) is a registered nurse who has completed advanced education (generally a minimum of a master's degree) and training in the diagnosis and management of common medical conditions, including chronic illnesses. Most nurse practitioners specialize in a particular field of medical care.
Nutrition Nutrition services refer to nutritional diagnosis and treatment by health professionals, including physicians, dieticians, behavioral health specialists, and nutritionists. The nutrition programs of the Older Americans Act, found in Title IIIC, are usually identified in appropriations bills as three activities: congregate nutrition services, home-delivered nutrition services (“Meals on Wheels”), and nutrition services incentives program, and are provided by a variety of allied health professionals.
Obstetrics Gynecology An obstetrician is a physician who has successfully completed specialized education and training in the management of pregnancy, labor, and pueperium (the time-period directly following childbirth). A gynecologist is a physician who has successfully completed specialized education and training in the health of the female reproductive system, including the diagnosis and treatment of disorders and diseases. An obstetrician/gynecologist is a physician specialist who provides medical and surgical care to women and has particular expertise in pregnancy, childbirth, and disorders of the reproductive system. An obstetrician/gynecologist, commonly abbreviated OB/GYN, can serve as a primary physician.
Occupational Therapy Occupational therapists provide skilled treatment to help individuals develop, regain, or maintain the skills necessary to participate in all facets of their lives. This health profession helps people whose lives have been altered by physical or mental disease, injury, or other health problems. Occupational therapists can provide: customized treatment programs to improve one's ability to perform daily activities, home and job site evaluations with adaptation recommendations, performance skills assessments and treatment, adaptive equipment recommendations and usage training, guidance to family members and caregivers.
Oncology Oncology is the field of medicine concerned with the diagnosis and treatment of cancer. While cancer can occur anywhere in the body, all cancers have one thing in common – they are caused by the out-of-control growth of abnormal cells. Chemotherapy drugs are used to kill cancer cells and slow the progression of the disease.
Ophthalmology Medical doctors that deal with ophthalmology, or the study of the eye, its appendages, and related diseases.
Optician An optician is a licensed health care practitioner who provides lenses for the correction vision problems.
Optometry Optometry is a health care profession concerned with eyes and related structures, as well as vision, visual systems, and vision information processing.
Oral Pathologist Is the specialty of dentistry and pathology concerned with recognition, diagnosis, investigation and management of diseases of the oral cavity, jaws, and adjacent structures
Oral Surgeon The branch of dentistry concerned with the surgical and adjunctive treatment of diseases, injuries, and deformities of the oral and maxillofacial region.
Orthodontist Orthodontics is the branch of dentistry that specializes in the diagnosis, prevention and treatment of dental and facial irregularities
Orthopedics Orthopaedics is a surgical specialty devoted to the diagnosis, treatment, rehabilitation and prevention of injuries and diseases of the musculoskeletal system. This complex system includes bones, joints, ligaments, tendons, muscles, and nerves. Once devoted to the care of children with spine and limb deformities, orthopaedics now cares for patients of all ages, from newborns with clubfeet to young athletes requiring arthroscopic surgery to older people with arthritis.
Osteopathic Osteopathy refers to the practice of osteopathic physicians. Osteopathic physicians believe a proper working musculoskeletal system is at the core of a person's well-being. They regard the body as a unit, not a collection of separate parts. Doctors of osteopathy (DOs) base diagnosis and treatment on the idea that the body's systems are interconnected. Instead of treating specific symptoms or illnesses.
Otolaryngology Otolaryngology is the branch of medicine that specializes in the diagnosis and treatment of ear, nose, throat, and head & neck disorders. Practitioners are called otolaryngologists. A commonly used term for this specialty is ENT (ear, nose and throat).
Palliative Care A form of medical care or treatment that concentrates on reducing the severity of disease symptoms, rather than striving to halt, delay, or reverse progression of the disease itself or provide a cure.
Pathology Pathology is the study of the causes and processes of diseases through microscopic study.
Pediatric Cardiology Pediatric cardiology is the study and treatment of children with diseases of the heart and blood vessels. A cardiologist is a physician who specializes in treating heart conditions such as abnormal heart rhythms, heart attacks, coronary artery disease, congenital heart defects, and disease of the heart valves. A pediatric cardiologist specializes in treating infants, children and adolescents with cardiovascular problems.
Pediatric Dental a specialist in the field of dentistry - dealing particularly with the oral healthcare of children, from infancy through the teenage years.
Pediatric Infectious Disease Pediatric infectious disease medicine is the science and treatment of infectious disease in infants, children and adolescents. A pediatric infectious disease physician is a pediatrician who deals with infectious diseases of all types in children, including respiratory infections, HIV, parasitic infections, and some allergies. This specialist deals with infectious and communicable diseases caused by viruses, bacteria, or parasites.
Pediatric Pulmonology A pulmonologist specializes in the functioning, diagnosis, and treatment of the lungs. Pulmonologists treat patients with a variety of lung and breathing diseases and conditions. Pulmonologists commonly treat diseases such as pneumonia, asthma, emphysema, and bronchitis.
Pediatric Rheumatology Diagnosis and nonsurgical treatment of arthritis and some disorders of the immune system of infants, children and adolescents.
Pediatric Surgery Pediatric surgery is a subspecialty of surgery involving the surgery of fetuses, infants, children, adolescents, and young adults. Many pediatric surgeons practice at children's hospitals.
Pediatrics Pediatrics is the treatment of disorders and diseases in infants, children and adolescents. A pediatrician is primarily concerned with the influence of disease and dysfunction on a child’s development, from preventive care to treatment of diseases. This specialist has background knowledge regarding congenital defects, immunology, oncology, infectious diseases, immunizations, and disorders that are unique to children.
Perinatology A subspecialty of obstetrics concerned with care of the mother and fetus during pregnancy, labor, and delivery, particularly when the mother or fetus is at a high risk for complications. Physician certification is available in neonatal-perinatal medicine by the American Board of Pediatrics and American Board of Obstetrics.
Periodontist Periodontics is the branch of dentistry concerned with the prevention, diagnosis and treatment of diseases affecting the gums and supporting structures of the teeth. Periodontists are also expert in the placement and maintenance of dental implants.
Physical & Rehabilitation Medicine Physical medicine and rehabilitation, also referred to as rehabilitation medicine, is the medical specialty concerned with diagnosing, evaluating, and treating patients with physical disabilities. A physical medicine physician, also called a physiatrist, treats diseases and disorders including neck and back pain, and sports injuries or disorders resulting from trauma, such as spinal cord injury or head injury. The primary goal of the physiatrist is to achieve maximal restoration of physical, psychological, social and vocational function through comprehensive rehabilitation.
Physical Therapy Physical Therapy is providing services to people and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan. It includes the provision of services in circumstances where movement and function are threatened by the process of aging or that of injury or disease. Physical therapy is concerned with identifying and maximizing movement potential, within the spheres of promotion, prevention, treatment and rehabilitation.
Physician Assistant A physician assistant (PA) is an individual who is a graduate of a physician assistant program accredited by the Accreditation Review Commission on Education for the Physician Assistant or by one of its predecessor agencies; and/or who is certified by the National Commission on Certification of Physician Assistants; and who is licensed, registered, or certified to practice medicine with physician supervision. Common services provided by a PA include taking medical histories and performing physical examinations; ordering and interpreting lab tests; diagnosing and treating illnesses; assisting in surgery; prescribing and/or dispensing medication; and counseling patients.
Podiatry Podiatry is a field of medicine that strives to improve the overall health and well-being of patients by focusing on preventing, diagnosing, and treating conditions associated with the foot and ankle. Doctors of Podiatric Medicine (DPMs) are physicians and surgeons who practice on the lower extremities, primarily on feet and ankles.
Preventive Medicine Preventive medicine is the science of promoting health and wellness, and preventing disease. A preventive medicine physician works to protect and maintain health, and to prevent disease, disability and premature death. This physician commonly specializes in one of three areas: public health, occupational medicine, or aerospace medicine. A physician completes a preventive medicine fellowship after an internship or residency.
Primary Care Provider A physician chosen by or assigned to a patient, who both provides primary care and acts as a gatekeeper to control access to other medical services.
Prosthetics/Orthotics Prosthetics is the art and science of developing artificial replacements for body parts. Orthotics is an allied health care field concerned with the design, development, fitting and manufacture of orthoses. Orthoses, sometimes called braces or splints, are devices that support or correct musculoskeletal deformities and/or abnormalities of the body.
Prosthodontist A dentist with special training in making replacements for missing teeth or other structures of the oral cavity to restore the patient's appearance, comfort, and/or health
Psychiatry Psychiatry deals with prevention, assessment, diagnosis, treatment and rehabilitation of mental illness.
Psychiatry - Child & Adolescent A Psychiatrist with additional training in the diagnosis and treatment of developmental, behavioral, emotional and mental disorders of childhood and adolescence.
Psychology Psychology is the study of the mind and behavior. The discipline of psychology embraces all aspects of the human experience — from the functions of the brain to the environments in which humans and other animals develop; from child development to aging. Psychologists study two critical relationships: one between brain function and behavior, and one between the environment and behavior.
Pulmonary Disease Pulmonary diseases are those diseases of the lungs, airways, and all other respiratory organs. A pulmonary physician is called a pulmonologist. The pulmonologist diagnoses and treats pneumonia, asthma, bronchitis, emphysema and other respiratory problems, and uses a variety of invasive and non-invasive diagnostic techniques to help patients.
Radiology Radiology is the branch of medicine that uses radioactive substances, electromagnetic radiation and sound waves to create images of the body, its organs and structures to prevent, diagnose and treat disease. Images can also show how effective the body and its internal organs and structures are functioning.
Rehabilitation To restore to useful life, as through therapy and education or to restore to good condition, operation, or capacity.
Rheumatology Rheumatology is the study of rheumatic illnesses, especially arthritis. A rheumatologist is a physician who diagnoses and treats arthritis and other conditions associated with joints, muscle, bones and tendons. This physician specializes in non-surgical treatment of diseases, and works with patients who have unexplained conditions such as weakness, fever, fatigue and weight loss.
Skilled Nursing Facility A skilled nursing facility is a facility (which meets specific regulatory certification requirements) that primarily provides inpatient skilled nursing care and related services to patients who require medical, nursing, or rehabilitative services, but does not provide the level of care or treatment available in a hospital.
Sight Impaired Having impaired vision; partially sighted.
Sleep Disorders Sleep disorders arise from many causes, including dysfunctional sleep mechanisms, abnormalities in physiological functions during sleep, abnormalities of the biological clock, and sleep disturbances that contribute to difficulty achieving restful, restorative sleep.
Speech Pathology Treatment of speech impairment.
Speech Therapy Speech and hearing therapy (also known as speech-language pathology and audiology) are health-related specialties concerned with normal development of human communication and treatment of its disorders. Speech therapy focuses on voice and speech-language skills, while hearing therapy deals with hearing and hearing impairment.
Sports Medicine Sports medicine focuses on physical fitness and the diagnosis and treatment of injuries sustained in sports activities. Sports medicine physicians are usually trained in Physical Medicine & Rehabilitation or Orthopedic Surgery.
Surgery Neurological Neurological surgery encompasses the surgical, nonsurgical and stereotactic radio surgical treatment of adult and pediatric patients with disorders of the nervous system: disorders of the brain, meninges, skull base, and their blood supply; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column; and disorders of the cranial and spinal nerves throughout their distribution. Neurological surgery is performed by physicians trained as neurosurgeons.
Surgery Oncology Diagnosis and treatment of tumors and malignancy.
Surgery Thoracic Thoracic surgery is the repair of organs located in the thorax, or chest. The thoracic cavity lies between the neck and the diaphragm, and contains the heart and lungs, the esophagus, trachea, pleura, mediastinum, chest wall, and diaphragm. General thoracic surgery deals specifically with disorders of the lungs and esophagus. Cardiothoracic surgery also encompasses disorders of the heart and pericardium.
Surgery Vascular Vascular surgery is surgery to treat disorders and diseases of the vascular system (the blood vessels of the body). A vascular surgeon performs surgery on patients with diseases, disorders, or inflammation of the veins and arteries. These diseases of the blood vessels can include vasculitis, aneurysms, ischemia, thrombosis, varicose veins, and immune system abnormalities.
Toxicology Toxicology is the study of the adverse effects of chemicals on living organisms. It is the study of symptoms, mechanisms, treatments and detection of poisoning.
Urgent Care Urgent care is defined as the delivery of ambulatory medical care outside of a hospital emergency department on a walk-in basis without a scheduled appointment. Urgent care centers treat conditions that are not life-threatening but need quick attention.
Urology Urology is the surgical specialty that deals with disorders or diseases of the male genito-urinary tract and female urinary tract, although only some people presenting with urological problems need surgery. Problems commonly treated by urologists include benign prostatic hyperplasia, prostate cancer, bladder cancer, voiding dysfunction, kidney stones, kidney cancer, erectile dysfunction, and scrotal swellings.

As a Moda Health member, you have access to a network of selected health providers. These in-network providers have contracted with Moda Health to provide benefits at agreed upon rates. You can choose to see an out-of-network provider, but you may have more out-of-pocket expense. You'll get the most from your health benefits by selecting an in-network provider. To learn what Moda Health network you are on, please consult your Member Handbook.


Our networks

Individual plans

Networks for plans purchased by individuals and families who live in:


  • Affinity
  • Beacon
  • Medicare Advantage

Group plans

Networks for plans provided through employers based in:


  • Community Care Network
  • Connexus
  • Connexus Alternative Care
  • Eastern Oregon CCO
  • Summit
  • Synergy


  • Central Peninsula Health Partners
  • Central Peninsula Health Partners — Primary Care
  • Endeavor Open
  • Endeavor PPO
  • Endeavor Providence
  • Endeavor Select

Other networks

Travel networks

Coverage while traveling, for urgent and emergency care:

  • First Health (Oregon members)
  • PHCS (Alaska members)

Out-of-area dependents

Coverage for dependents who live outside of the area, if applicable to your plan:

  • PHCS (Oregon and Alaska members)

Individual plans

Networks for plans purchased by individuals and families who live in:


  • Delta Dental PPO
  • Delta Dental Premier


  • Delta Dental PPO
  • Delta Dental Premier

Group plans

Networks for plans provided through employers based in:


  • Delta Dental PPO
  • Delta Dental Premier
  • ODS Community Dental / Medicaid
  • The Children's Program


  • Delta Dental PPO
  • Delta Dental Premier


For members with Moda Health pharmacy coverage.

Northwest Prescription Drug Consortium

For participants in the Oregon or Washington prescription drug programs.