Answers about selecting your Moda medical home and finding care

• What is a medical home?
• Do I have to pick a medical home?
• Can I go to a primary care provider who's not in my medical home?
• How do I find a medical home?
• Can I pick a naturopathic doctor as my medical home?
• Can I keep my current primary care doctor?
• How do I tell Moda Health about my medical home selection?
• Can I ever change my medical home?

What is a medical home?

Your Moda Health medical home is the place you go for your primary care needs. Your primary care provider works together with you and the rest of your care team to provide the best treatments for you. With a medical home, your care is more personal, convenient and easier to access.

Medical Home providers have been certified by the Oregon Patient-Centered Primary Care Program. Those certified may receive a Tier 1, Tier 2, Tier 3, Tier 4 or Tier 5 STAR designation on the Medical Home icon. The higher tier numbers reflect increased integration of, and access to, coordinated care.

Do I have to pick a medical home?

Yes. All Moda Health PEBB members must select a medical home before going in for care. Your medical home coordinates your care, including referrals to specialists or hospitals as needed.

If any member receives care before selecting a medical home, their claim(s) may be paid at the out-of-network benefit level.

Can I go to a primary care provider who's not in my medical home?

If any member receives care from a provider outside their selected medical home, the claim(s) may be paid at the out-of-network benefit level.

How do I find a medical home?

Selecting your Moda medical home is easy. Just follow these steps:

Already a member?

• Visit modahealth.com/PEBB and log in to Member Dashboard. If you don't have a Member Dashboard account yet, simply create one using your Moda Health subscriber ID number.
• Once you're in Member Dashboard, choose the "Medical home" tab. This is where you set up or change your medical home. It also shows your medical home history.
• Click "Find Care" to search for a specific provider. Select "medical" as the type of care.
• Search for a specific provider by name, or choose "Medical Home Providers & Doctors" to browse a list (look for a building icon in the address box).

Not yet enrolled?

• Visit modahealth.com/PEBB and choose "Find Care."
• Select "Search as a guest."
• Choose "Medical" as the type of care; then select either the Summit or Synergy network.
• Search for a specific provider by name, or choose "Medical Home Providers & Doctors" to browse a list (look for a building icon in the address box).

If you need assistance or have any questions, please contact Customer Service at 844-776-1593.

Can I pick a naturopathic doctor as my medical home?

A Naturopath is not considered a Medical Home unless they are a certified primary care provider.

Can I keep my current primary care doctor?

If your primary care provider (PCP) is part of a Moda Health medical home, then you may be able to keep seeing them under your plan. Just check to see if your PCP is affiliated with a hospital or clinic in the Summit or Synergy network.

If your PCP is not affiliated with hospitals or clinics in the Summit or Synergy network, then they may not be covered under your plan.

How do I tell Moda Health about my medical home selection?

Before receiving care, let us know which Moda medical home you choose. Use one of these ways to tell us:

• Online
  • Visit modahealth.com/PEBB.
  • Log in to your Member Dashboard account using your subscriber ID number.
  • Click the "Medical home" tab to make your medical home selection. Covered family members age 18 and older will need to use their own Member Dashboard account to pick a medical home.
  • Saving your changes automatically informs us about your selection.
• Phone
  • Call Moda Health Customer Service toll-free at 844-776-1593.
• U.S. Mail
  • Visit modahealth.com/PEBB and download a medical home selection form under the "Resources" tab.
  • Mail your completed form to:
    
    

    Moda Health
    Attn: PEBB Billing and Eligibility
    PO Box 40384
    Portland, OR 97240

If you need to change your medical home selection, just use one of the above options to let us know.

Can I ever change my medical home?

Of course. You can switch to a different Moda Health medical home at any time, for any reason. Just be sure to tell us you've made the change before you visit your new medical home for care.

You can notify Moda Health about a medical home change in any of these ways:

• Online
  • Visit modahealth.com/PEBB.
  • Log in to your Member Dashboard account using your subscriber ID number.
  • Click the "Medical home" tab to change your medical home selection.
• Phone
  • Call Moda Health Customer Service toll-free at 844-776-1593 and let us know you want to change your medical home.
• U.S. Mail
  • Visit modahealth.com/PEBB and download a new "medical home selection form" under the "Resources" tab.
  • Select a new medical home, then mail your completed form to:
    
    

    Moda Health
    Attn: PEBB Billing and Eligibility
    PO Box 40384
    Portland, OR 97240

If you need help or have any questions, please contact Customer Service toll-free at 844-776-1593.