Credentialing
Moda requires credentialing for a variety of medical, behavioral health, and alternative care provider types. For a complete list of practitioner types that require credentialing, please see our Moda Practitioner Classification Table. In addition, we also credential organizational providers under the following categories:
Organizational providers are required to be credentialed at each licensed site that is contracted with Moda.
Moda does not credential inpatient setting only practitioners. These are providers who practice exclusively in an inpatient setting and who provide care only as a result of a member's treatment in an inpatient setting. Providers working exclusively in the emergency room of a hospital are considered hospital based, whether providing inpatient or outpatient services.
Provider specialties that fall under this definition per the National Committee for Quality Assurance (NCQA) include: pathology, radiology, anesthesiology, neonatology, emergency medicine and hospitalists.
Please note: Telemedicine providers would not fall under this definition of hospital based, as they are not located within the hospital facility. Full credentialing will be required for this provider type prior to being considered in-network.
Please submit a copy of the Hospital Based Provider Enrollment Form in order to be added to our credentialing and claims systems as hospital based only.
A practitioner who is new to the Moda panel and provides coverage for an absent practitioner, or due to practitioner shortage for a period of 90-consecutive calendar days or less, is not required to complete the full credentialing process. Rather, an expedited process will approve credentialing for the locum tenens coverage period.
Please contact the Moda Health Credentialing department for details on what's required for an expedited locum tenens credentialing process.
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We have exciting news to share. ODS is changing its name to Moda Health.
Moda comes from the latin term "modus" and means "a way". We picked it because that's what we are here to do: help our communities find a way to better health.
Together, we can be more, be better.
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