Moda Health provider claims

Follow these step-by-step guides for filing claims with Moda Health.

Filing medical claims

Step 1: Gather patient information

• First and last name
• Date of birth
• Subscriber ID
• Valid CPT and ICD-10 codes
• Patient's relationship to the subscriber
• Plan information

Step 2: Confirm additional patient coverage (if applicable)

Patient covered by multiple Moda Health plans?

Please also gather the name of the employer (if applicable) and Moda Health group number for both plans

Patient also covered by a second health plan?

Please also gather the name, address and policy number of the other carrier. If the other carrier is the patient’s primary insurance, request and obtain an Explanation of Benefits (EOB) from that carrier to include with your claim.

Step 3: Review tips to expedite your claim

Complete information. Always include the patient information listed above in Step 1, along with the full name and address of the provider, the National Provider Identifier (NPI) and the Tax ID number.

Avoid highlighters on claims. They can interfere with the scanning process on paper claims and delay your claim.

Avoid duplicate submissions. Check the status of your claims in Benefit Tracker before resubmitting a claim. Duplicate submissions can cause delays in processing your claim.

Submit electronically. It saves time, reduces costs and improves accuracy. Electronic claims reach us in seconds to 24 hours, and there’s less chance of errors.

Follow timely filing guidelines. In most cases, claims must be submitted no later than 365 days after the date of service.

Step 4: Submit your claim

When you submit your claim electronically, you may dramatically reduce the processing time for your claim. Each day, Moda Health processes electronic claims first, before paper claims are processed. Select one of the electronic claims providers who work with Moda Health to process your claim. By opening an account with one of these companies, you give them permission to deposit funds into your bank account on behalf of Moda Health.

Moda Payer ID: 13350

Systems that submit directly to Moda Health:

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