We are working to help make healthcare costs more transparent. If you are a Moda Health member and want to find out the cost of care, visit the Healthcare Cost Estimator in your Member Dashboard. The Estimator has more than 200 medical codes that will help you understand how much insurance covers, how much you will pay and how much different providers charge. In 2023, this tool will add even more codes so it will be easier to find more information on more procedures.
Machine Readable Files are a tool for healthcare industry experts. These files share our negotiated rates, allowed amounts and billed charges. To view these files, you will need software tools that allow you to read very large files in the CMS JSON format. If your system has limited capability, they may not be downloadable. Download speeds and time are dependent on your internet speed, browser and computer hardware. To download these files, an application designed to handle large data files may be recommended. Depending on your operating system, you may need to download a tool to open.
Moda Health will update these Machine Readable files monthly.
To determine if you are a Non-ASO Group or an ASO Group, please call our customer service team at 888-217-2363.
Here's the legal language that talks through Machine Readable Files.
The Departments of the Treasury, Labor, and Health and Human Services issued the Transparency in Coverage final rules on November 12, 2020. The rules require health insurance issuers in the individual and group markets (plans and issuers) to disclose certain pricing information. Under the final rules a plan or issuer must disclose in-network negotiated rates and out-of-network billed and allowed rates through two machine-readable files posted on an internet website.
Machine-readable files published by Moda Health conform to the technical implementation guide and schema version 1.0.0 published by CMS at https://github.com/CMSgov/price-transparency-guide
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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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