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Billing and claims


Following is how to process billing and claims with us. Please note that this info applies to contracted providers. Contact us if you are not a contracted provider.

Please review our Reimbursement Policy Manual for details on specific types of reimbursements.

 

Electronic claims and transactions

We encourage electronic claim submission--your office gets quicker submission, higher accuracy, better tracking and lower administrative costs.


Direct connection to Moda Health

We support direct connections between our offices, provider offices and health systems. The transaction standard is the 837 Professional Claim or 837 Institutional Claim required by HIPAA Administrative Simplification. See our Electronic remittance explanation codes for details. For help with Moda Health EDI transactions, either contact us or send an email to edigroup@modahealth.com.

Claims clearinghouses

Below is a list of claims clearinghouses we use:


Availity
12400 Coit Rd. #700
Dallas, TX 75251
800-282-4548
Payor ID = 13350

Change Healthcare (formerly Emdeon) (both medical and hospital)
3055 Lebanon Pik
Nashville, TN 37214
(615) 932-3000 
Payor ID = 13350 

MCPS Inc 
1740 S. Glenstone #B
Springfield, MO 65804
417-890-6164 

MD On-Line Inc.
6 Century Dr
Parsippany, NJ,07054
888-499-5465 

Office Ally
P.O. Box 872020
Vancouver, WA 98687
360-975-7000


RelayHealth (both medical and hospital)
301 Data Court 
Dubuque, IA 52003
563-557-3925 

Systems that submit directly to Moda Health: 

LINCARE Inc. 
19387 US 19 N 
Clearwater, FL 33764
727-431-8231


Mailing address

Medical Claims
P.O. Box 40384
Portland, OR 97240

Pharmacy Claims
P.O. Box 3625
Portland, OR 97208 

Questions?

See a full list of contact details including provider relations and customer service.

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