Prior authorization with eviCore

On April 1, 2017, we will be replacing AIM Specialty Healthcare with utilization management programs for advanced imaging (cardiology, radiology, ultrasound) and musculoskeletal services (spine/joint surgery, spine/joint pain management and alternative care) with eviCore healthcare.

This change impacts how providers request and obtain prior authorizations for medical services.

Please note: if a member sees a provider who is out of network it may lead to higher out-of-pocket costs. The member cost will vary based on the following conditions:

We continue to contract directly with providers and are committed to offering a robust network to our members. If you are not sure if your provider is in-network, please visit modahealth.com and access Find Care, our online provider directory.

Why we focus on utilization management

Utilization management (UM) includes medical reviews for services that require prior authorization. Following evidence-based care guidelines, UM helps ensure patients receive the highest quality of care at lower costs. While the adoption of evidence-based care protocols remains an industry challenge, UM supports medically appropriate care through responsible decision-making and better cost management.

Our partnership with eviCore is focused on providing members with high-quality, cost-effective care that results in better health outcomes. With eviCore's streamlined prior authorization process, you access the care you need when you need it.

Questions?

We're here to help. Please contact our customer service team at 877-605-3229.

To learn more about Moda's prior authorization services through eviCore, please see our FAQ.

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 Synergy, Summit, and EOCCO provider contacts

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.