INSURER FILING GUIDE

Moda Health

Use this public information to prepare your packet, then confirm the route on the insurer's own page.

AT A GLANCE

Claim facts

Member form	HEALTH INSURANCE CLAIM FORM Number: CMS-1500 Revision: 02/12; document mark 37561487 (4/18) Open the insurer form
Portal upload	NO
Portal path	No upload path: the current transparency page and claim form publish offline submission; member account page is published for EOB and status access
Mail address	MODA HEALTH PLANS, PO BOX 40384, PORTLAND, OR 97240
Fax	Not published by the insurer
Attachments	For the itemized-receipt alternative: date of service, service provided, and amount. The CMS-1500 route prints patient, insured, provider, diagnosis, procedure, service-line, charge, and certification fields
Deadline	Within 12 months of date of service
Outcome and status	Member account page > EOBs and claim status
Processing time	Denial EOB within 30 days; delay notice within 30 days and final EOB no more than 45 days after receipt; after requested information arrives, 15 days
Caveats	An itemized receipt with the published fields is accepted without the CMS-1500; whether a document titled superbill qualifies depends on its contents. EPO and network-only products may lack ordinary out-of-network benefits. Group, self-funded, Medicare, and Medicaid terms differ

STEP BY STEP

Read date: 10-09-2026

Confirm the plan has out-of-network benefits. The member account page plan document controls. https://www.modahealth.com/oregon/member/resources/forms-handbooks-and-coverage/handbooks
Use the Moda medical and vision CMS-1500 claim form, or the current transparency page's itemized-receipt alternative. The receipt must state the date of service, service provided, and amount. https://www.modahealth.com/-/media/modahealth/shared/Forms/Moda-Health-MED-Claim-Form.pdf and https://www3.modahealth.com/oregon/member/resources/forms-handbooks-and-coverage/transparency-in-coverage
If using CMS-1500, complete its patient, insured, diagnosis, service-line, provider, charge, authorization, assignment, and certification fields. https://www.modahealth.com/-/media/modahealth/shared/Forms/Moda-Health-MED-Claim-Form.pdf
NOT PUBLISHED: a member portal or app claim-upload path. The current page and form publish an offline route, so portal_upload is NO. Do not use an offline destination from this map. https://www3.modahealth.com/oregon/member/resources/forms-handbooks-and-coverage/transparency-in-coverage
Submit within 12 months after the service date. Check the EOB in member account page. Moda publishes a denial EOB within 30 days, a delay notice within 30 days when needed, and final processing within the stated extension periods. https://www3.modahealth.com/oregon/member/resources/forms-handbooks-and-coverage/transparency-in-coverage

Portal upload: NO
Portal: member account page status only
Portal path: No upload path: the current transparency page and claim form publish offline submission; member account page is published for EOB and status access
Mail address: MODA HEALTH PLANS, PO BOX 40384, PORTLAND, OR 97240
Fax: NOT PUBLISHED
Attach: For the itemized-receipt alternative: date of service, service provided, and amount. The CMS-1500 route prints patient, insured, provider, diagnosis, procedure, service-line, charge, and certification fields
File types: NOT APPLICABLE
File size limit: NOT APPLICABLE
Maximum files: NOT APPLICABLE
One file or separate files: NOT APPLICABLE
Confirmation: EOB in member account page; email when an EOB is available
Status check: member account page > EOBs and claim status
Processing time: Denial EOB within 30 days; delay notice within 30 days and final EOB no more than 45 days after receipt; after requested information arrives, 15 days
Member deadline: Within 12 months of date of service
Deadline basis: YES: member account page plan documents control
Mental health route: NOT PUBLISHED: no distinct outpatient psychotherapy member filing route found

Confirm the address, fax number or portal path on the insurer's own claims page before you send; read on 10-09-2026.

Read on 10-09-2026 from https://www.modahealth.com/-/media/modahealth/shared/Forms/Moda-Health-MED-Claim-Form.pdf. Confirm the address, fax number or portal path on the insurer's own claims page before you send.