Moda Health. Healthcare from your head to your toes. Delta Dental | Moda Health

Provider frequently asked questions

What is considered a medical emergency?

Emergency medical condition means a medical condition that manifests itself by symptoms of sufficient severity that a prudent layperson possessing an average knowledge of health and medicine would reasonably expect that failure to receive immediate medical attention would place the health of a person, or a fetus in the case of a pregnant woman, in serious jeopardy.*

Return to top

Do members need a referral for routine services such as vision, GYN/PAP, etc.?

No, they can self refer to a participating optometrist for vision services or an OB/GYN for routine annual women's exam and maternity care.

Return to top

What if a member is not sure if they have medical eligibility?

To verify eligibility, the provider may inquire using Benefit Tracker. If the provider has not registered, then the member or provider should contact customer service.

Return to top

How do I appeal a denied and/or reduced claim?

First contact customer service for that group. If they cannot adjust the claim to pay based on any new information you give them, then you can mail an appeal letter to the Moda Health Complaint Management department. The letter should state clearly and concisely why you feel it should have been paid or paid at a higher level. Chart notes or other medical documentation can be included with the appeal letter.

Return to top

Can each family member select a different PCP?

Yes, if the medical plan utilizes a PCP, each covered family member can select a different PCP.

Return to top

How does a patient change from one PCP to another?

Patients have the option of changing PCPs within their plan's network up to two times per calendar year. The change will be effective the first of the month following the date of the request. When they have selected a PCP who is accepting patients, they should contact customer service or fill out the online form. A new ID card will be sent to the patient within five to 10 working days.

Return to top

Does an existing patient who is new to Moda Health need new referrals?

Yes. With a new insurance carrier, historical information regarding records of referrals and authorizations do not follow. Patients should notify their PCP that their insurance coverage is now with Moda Health and ask him or her to call Moda Health with your referral information.

Return to top

How do I get information in the physician directories updated?

Send a message to our Medical Professional Relations team.

Return to top

*This is our standard contract wording. Please refer to the member's Member Handbook for specific plan information.

Moda Health Provider Network

Find a physician, pharmacy or clinic

Opt in for medical

Tell us you're interested and we'll be in touch with details.

Get Started  Get Started

Questions?

If you can't find an answer, please feel free to contact our Customer Service Customer Service Customer Service

Questions?

If you can't find an answer, please feel free to contact our Customer Service

Employer web tools

Benefit Tracker

Check benefits and eligibility

Log in

Account help

Request an account

Provider Reports

For value-based provider programs, including Synergy, Summit, Beacon, Affinity, CPC+, and EOCCO

Log in

Join our email list


Benefit Tracker

Check benefits, eligibility, incentive and utilization

Log In

Account help

Create an account

Producer web tools


Hello.

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.

Please select the state you live in, or the state where your employer is headquartered, so we can tailor your experience:

Hello.

Please select the state you live in, or the state where your employer is headquartered, so we can tailor your experience:

Changing your location to Oregon

You can return to your previous location in the site header.