Medical credentialing and contracting
Become a participating provider
Thank you for your interest in becoming a participating provider in the Moda Health medical network. As our partner, you will get competitive reimbursement rates, excellent customer service, convenient online tools and more. Find out more about how we can work together.
If you would like to partner with us, please follow the instructions, below.
Announcement
As part of Moda’s ongoing commitment to a better provider experience, we are pleased to share that we are partnering with symplr CVO to improve our credentialing turnaround times. Moda is augmenting its dedicated, in-house Credentialing team with a new, short term partnership with Symplr CVO. Symplr will assist Moda by providing Primary Source Verification services on Moda’s behalf. Symplr is a NCQA certified CVO, which assures you of their quality and reliability.
During the processing and verification stages of initial and recredentialing with Moda, symplr may outreach directly to providers on Moda’s behalf. Please respond promptly to any requests to ensure that the process is thorough, timely, and accurate.
This new partnership will allow Moda to work concurrently with symplr and complete all pending applications in a more timely manner, ensuring that providers are credentialed more quickly and effectively.
Medical credentialing
Moda utilizes the CAQH ProView as an application source. Once you have been approved for contracting, you will be prompted to share you CAQH ID with us to begin credentialing.
Important Note: CAQH must reflect that Moda has permission to access this application. The application must be up to date with current attestation status to allow the application to be used. Outdated, or incomplete applications will not be accepted or processed.
If you do not use CAQH, we also accept credentialing applications directly. You can submit it to us by email, fax or regular mail.
Credentialing@modahealth.com
Phone: 855-801-2993
Fax: 503-265-5707
Mailing Address:
Moda Health
Attn: Credentialing Dept.
601 SW 2nd Ave, # 900
Portland, OR 97204
Additional Resources:
Practitioner rights
Practitioners have rights during the credentialing and recredentialing process and are notified of these rights through various means.
Practitioners have the right to:
- Credentialing and recredentialing decisions that are not based on the practitioner's race, ethnic/national identity, gender, age, sexual orientation or the types of procedures performed (provided such procedures are legal under US law) or patients in which the practitioner specializes. This includes information obtained from outside sources except for reports from the National Practitioner Databank.
- Review information the practitioner submitted to Moda Health to support their credentialing application.
- Correct erroneous information discovered during the verification process. The credentialing specialist will send three written requests with a 7-day deadline to allow the provider to clarify any discrepancy found. Contact information for the credentialing specialist will be provided at the time of the request.
- Request and be informed of the credentialing application status. The credentialing staff will respond to status requests within 2 weeks of receipt.
- Withdraw, in writing, the application at any time.
- Have the confidentiality of the application and all supporting documents protected and the information used for the sole purpose of application verification, peer review and panel participation decisions, subject to any disclosures required under state or federal law.
- Be notified of these rights.
- Participating providers have the right to appeal application denials and adverse action taken by Moda Health as outlined in the Appeal of Moda Health Adverse Action.