How To Submit Claims To Moda Health Plan,

Moda Health Plan,'s reviewed provider guidance starts with this submission channel: Electronic claim submission via direct EDI. Confirm the member plan and claim type before using a payer ID or paper address.

At a glance

• Moda supports electronic and paper claim workflows. Official provider materials identify electronic claim submission through direct EDI connections and clearinghouses, including Availity, Change Healthcare/Emdeon, MCPS, and MD On-Line for the Idaho provider channel, with payor ID 13350 shown for several connections. Moda also accepts mailed claims/correspondence at its Portland P.O. Box address. Specific corrected-claim instructions are not fully standardized in the retrieved official sources, but commercial timely filing guidance ties corrected/reconsideration claims, disputes, and appeals to the Moda EOP date.

Submission channels

• Electronic claim submission via direct EDI
• Electronic submission via clearinghouses
• Paper/mail submission

Electronic claims payer IDs

• 13350

Paper claims addresses

• Moda Health, P.O. Box 40384, Portland, OR 97240-0384

Corrected claims and follow-up

• Commercial provider manual: corrected/reconsideration claims, claim disputes, and appeals are measured from the date of the Moda EOP to the date received by Moda Health.

• Provider materials indicate providers should preserve mailing logs or other proof of submission when filing by mail.

• Claims status resource 1

Caveats

• Electronic submission details vary by product/channel; the clearest payer ID evidence found is in the Idaho provider billing page and EOCCO materials.
• A comprehensive, product-neutral claim submission manual was not located in the retrieved sources.
• Paper claim addresses may vary by line of business; the Portland P.O. Box 40384 address is confirmed for Moda Health correspondence and Medicare Advantage mail claims.

Provider resources

• Medical provider contact us (official)
• Referral and Authorization Guidelines (official)
• Commercial Provider Manual (PDF) (official)
• Medicare Advantage Provider Manual (PDF) (official)
• Provider billing and claims | Moda Health Idaho (official)

Sources