Moda Health Plan
Moda Health Plan is a regional health plan operating in Alaska, Idaho, Oregon, and Texas. For an ASC, what matters isn't the logo. It's how Moda Health Plan pays: where it runs rich, where it runs thin, and how its reimbursement compares with peer plans for the same procedures.
Pilot Analysis
Get the complete Moda Health Plan analysis
Tell us where to send it. Our team will prepare an analysis of Moda Health Plan covering rates by code, market position, and underpaid areas, and email it to you within 5-10 business days. Need it faster? Book a demo.
What Insights reveals
How Moda Health Plan pays
See how Moda Health Plan reimburses across procedures and markets, benchmarked against the peer plans competing for the same cases. Not a raw rate sheet, a read on where it sits.
Geographic footprint
Moda Health Plan's presence spans Alaska, Idaho, Oregon, and Texas. See where it concentrates and how that shapes the markets you compete in.
Peer position
Put your own position next to the benchmark for Moda Health Plan and bring the gap to your next contract conversation.
Specialty mix
Understand which procedures and specialties drive Moda Health Plan's volume, so you know where a rate change moves the needle.
Whether you're an ASC benchmarking a contract or a provider team looking Moda Health Plan up, DataLily AI maps how it reimburses across procedures and markets, and where your own rates sit against the peer benchmark.
Reference
Working with Moda Health Plan
- Payer ID
- 13350 is the EDI identifier used to route electronic eligibility checks (270/271), claim-status inquiries (276/277), and claims to Moda Health Plan through a clearinghouse.
- Eligibility verification
- Coverage and benefits for Moda Health Plan members are verified before the date of service, through a clearinghouse using payer ID 13350or through the payer's provider portal.
- Prior authorization
- Requirements are set per plan and per procedure. Confirm whether an authorization is required with Moda Health Plan directly before the date of service.
Book a demo: pick a time
A 15-minute walkthrough of Moda Health Plan the way it pays.
- What is Moda Health Plan's payer ID?
- Moda Health Plan's electronic payer ID is 13350. ASC billing teams use it to route eligibility checks (270/271), claim-status inquiries (276/277), and electronic claims to Moda Health Plan through a clearinghouse.
- How do ASCs verify eligibility for Moda Health Plan members?
- Eligibility and benefits for Moda Health Plan members are verified before the date of service, either electronically through a clearinghouse (a 270/271 transaction using payer ID 13350) or through the payer's provider portal.
- Does Moda Health Plan require prior authorization for ASC procedures?
- Prior-authorization requirements for Moda Health Plan are set per plan and per procedure. Confirm whether an authorization is required with Moda Health Plan directly before the date of service.
- What type of payer is Moda Health Plan?
- Moda Health Plan is a regional health plan operating in Alaska, Idaho, Oregon, and Texas.
- How does Moda Health Plan compare with other payers for ASC procedures?
- Ask Rose and you get a plain-language read on where Moda Health Plan pays above or below peer plans for your top procedures, charted, and ending in a recommendation you can take into a contract conversation.
- Is Moda Health Plan paying my ASC below market?
- Put your own Moda Health Plan contract next to the peer benchmark in DataLily AI and you'll see the gap by procedure and market, the fastest way to know whether you're leaving money on the table.