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What medical provider networks will be used for OEBB members?

Active employees and their dependents in Oregon, Idaho, southwest Washington and northern California who have selected a Moda PPO plan will use the Connexus Network. Employees who have selected a Moda Synergy plan will use the Synergy Network. Employees who have selected a Moda Summit plan will use the Summit Network.

Retirees, COBRA members and their dependents who have selected a Moda PPO plan but reside outside the state of Oregon will use the following networks:

  • Washington, excluding southwest and south central Washington — First Choice Network (FCH)
  • Montana — Health InfoNet (HIN)
  • Alaska — Providence Endeavor
  • All other states — Private Healthcare Systems (PHCS)

The Moda Health travel network allows medical plan members to receive emergency and nonemergency care outside of their primary service area while traveling. Eligible members need to seek care from a First Health Network provider to receive in-network benefits. The Moda Health travel network is not an alternative primary network. Members must seek in-network services whenever possible, and preauthorization is required for in-patient services.

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What dental provider networks will OEBB members use

Active employees, retirees and their dependents enrolled in OEBB plans 1, 5, and 6 will use the Delta Dental Premier Network. Active employees, retirees and their dependents enrolled in OEBB�s Exclusive PPO plan will use the Delta Dental PPO network. Services for members on the Exclusive PPO plan who seek care from a provider that is not part of the Delta Dental PPO network will not be covered. Both the Delta Dental Premier and Delta Dental PPO networks include access to the Delta Dental Provider Network nationwide.

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How can members find out if their medical provider is in or out of network?

OEBB members have access to either the Connexus, Synergy or Summit Network based on where they reside or work. Retirees may have a different network depending on where they reside (see question 1 above). Members can locate providers in their network by using our online Find Care tool and entering their OEBB ID number. Members who are not yet active on a Moda medical plan can search by network by selecting the appropriate network from the "Networks" drop-down box.

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If a specific clinic is not listed on the Moda Health website, how can members find out if their provider is part of their medical network with Moda Health?

The most effective search process is to search by the provider�s last name or ZIP code because providers with multiple practice specialties may not be listed under all of their specialties. Members can search for their provider by name, specialty, ZIP code or city in which the provider is located.

Members should be sure to select the appropriate network (Connexus, Synergy or Summit) based on which plan they are enrolled in. Moda Health customer service is also available to help members locate in-network providers.

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Can members nominate a provider to participate in their network?

Depending on the region, the Connexus Network panel may be open. The Synergy and Summit network options are closed networks and providers are typically only added as network expansion occurs.

New provider participation is contingent on credentialing approval, state and federal regulations, network needs, and other factors.

Here's how you can nominate a provider:

  1. Go to our OEBB provider networks page.
  2. Download and complete the medical provider nomination request form.
  3. Return the completed form to your provider�s office and let them know you would like them to initiate a network participation request with Moda.

Once your provider's application has been reviewed, a Moda Health Contract Negotiator will contact them to initiate a participation agreement within 14 business days.

Please note: Medical providers may indicate the desire to contract with Connexus initially, but ultimately choose not to contract for a variety of reasons. A request for a contract does not guarantee provider participation.

For the most up-to-date information on provider network participation, please visit our Find Care provider directory.

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If a provider is added to the network after a member receives services, will Moda Health reprocess the claim to pay the in-network level?

No. The provider will be paid the in-network rate only after being added to the network.

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If a member is a Retiree or COBRA recipient who resides outside of Oregon, Washington, Idaho and Montana, he or she will use the PHCS network. When these members access this network online, they are required to indicate what logo is on their ID card. If these members do not have an ID card when logging on, what logo should they click on?

Members should check the box next to the first option, “PHCS” under “Front of Card.” Members do not need to select anything under the “Back of Card” section.

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What pharmacy network will be used for OEBB members?

OEBB members will use the Oregon Prescription Drug Plan (OPDP) pharmacy network, also referred to as the NW Prescription Drug Consortium network.

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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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