For Claims and Appeals, please see procedures below based on line of business.
If you are a non-contracted provider, you have 60 calendar days from the remittance notification date to file a request for reconsideration of the plan’s denial of payment. Non-contracted providers must sign a Waiver of Liability form holding the enrollee harmless regardless of the outcome of the appeal. Download form: Medicare Waiver of Liability.
Non-contracted providers should include documentation such as a copy of the original claim, remittance notification showing denial, and any clinical records and other documentation that supports the provider’s argument for reimbursement.
Request for reconsideration should be sent to Moda Health, ATTN: Medicare Appeals Unit at P.O. Box 40384, Portland, OR 97204 or faxed to 503-412-4003.
Full instructions can be found here: Download the full instructions: Non-Contracted Provider Appeals & Provider Payment Disputes.
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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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