It’s only natural to have questions about your new Moda Health/Trust plan. If you can’t find the answer to your question here, please feel free to call our Customer Service Representatives.
Medical Customer Service: 855-294-1668
Pharmacy Customer Service: 855-264-1669
What is Member Dashboard?
As a Moda Health member, you have access to Member Dashboard, your personalized member website. With Member Dashboard, you can access health tools and resources to help you manage your health. To create your Member Dashboard account, please click on the �create an account� link in the Member Dashboard box on the right side of this screen. While in Member Dashboard, you can set your communication preferences for your EOBs. You can either receive EOBs electronically or through regular U.S. mail.
How can I find a doctor or clinic in my network?
Click on the box on the right side of this screen that says “Moda Health Provider Network: Find a physician, pharmacy or clinic”. As a Moda Health/AIMS member, your medical network is the First Choice Health PPO Washington and Connexus network. If you live outside of Washington, Oregon, or Idaho, your medical network is the PHCS network. Your pharmacy network is the Washington Prescription Drug Plan (WPDP) network.
If you are traveling, the Moda Health Travel Network allows you to receive emergency and nonemergency care outside of your primary service area. If you need care when you are traveling, you should choose a provider in the PHCS Healthy Directions network to receive in-network benefits.* If you have dependents living outside of the primary network area, your dependents can also use the Moda Health Travel Network to receive care at an in network benefit level.* 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.
How do I know what network I am in?
As a Moda Health/Trusts member, your medical network is the First Choice Health PPO Washington and Connexus network. If you live outside of Washington, Oregon or Idaho, your medical network is the PHCS network. Your pharmacy network is the Washington Prescription Drug Plan (WPDP) network.
If you are traveling, the Moda Health Travel Network allows you to receive emergency and nonemergency care outside of your primary service area. If you need care when you are traveling, you should choose a provider in the PHCS Healthy Directions network to receive in-network benefits.* If you have dependents living outside of the primary network area, your dependents can also use the Moda Health Travel Network to receive care at an in network benefit level.* 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.
How do I send in my claims?
Once you receive treatment, if your doctor, pharmacist or facility does not bill Moda Health for you, please send your claims to:
Medical claims
Moda Health
P.O. Box 40384
Portland, OR 97240-0384
Please include the following information with your medical claim:
If the treatment is for an accidental injury, include a statement with the date, time, place and circumstances of the accident when you send us the physician or professional provider’s bill.
Pharmacy claims
Moda Health
P.O. Box 40168
Portland, OR 97240
To submit pharmacy claims, please fill out the pharmacy claims form.
Can I see my claims online?
Yes. Once your coverage with Moda Health is active, you can see your claims online through your personalized member website, Member Dashboard. Member Dashboard also allows you to manage your benefits and access health tools and resources. To register for Member Dashboard, visit the Member Dashboard registration page on or after your effective date of coverage.
Is there a Member Handbook I can access?
Yes. Once your coverage with Moda Health is active, you can access your Member Handbook, claims and benefit information, health tools, and other resources on Member Dashboard, your personalized member website. To register for Member Dashboard, visit the Member Dashboard registration page on or after your effective date of coverage.
How can I view my benefits?
Once your coverage with Moda Health is active, you can view your benefits and claims information and access health tools and resources on Member Dashboard, your personalized member website. To register for Member Dashboard, visit the Member Dashboard registration page on or after your effective date of coverage.
Do I pay Moda Health when I get a bill from my medical provider?
No. If you receive a bill from your medical provider, verify that your provider is billing you for the charges your health plan did not cover. Once you have confirmed the bill is for charges not covered by insurance, pay your provider directly.
Can you help me understand the Explanation of Benefits (EOBs) I will be receiving?
Yes. You can view sample medical EOBs, which include a glossary and explanation.
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