Networks protect members, near and far
Each Moda Health medical plan and Delta Dental Plan of Oregon plan comes with a provider network. Each medical network is a group of licensed health professionals, clinics, pharmacies, labs and hospitals located in a certain area. These providers offer quality care and services to Moda Health members at an agreed-upon cost. Each dental network includes network dentists who accept the Delta Dental contracted fee so there will be no additional balance billing.
View our networks:
In-network care offers better value
Members get a better benefit and can save money by seeing in-network providers. These providers offer quality care and services to our members at an agreed-upon cost.
Care from out-of-network providers may also be subject to "balance billing" ‐ the difference between what the plan allows or reimburses and the providers' billed charges. In-network providers don't do this.
Is a provider in-network?
Members can find out by visiting modahealth.com and using Find Care. They choose a network and look for a doctor, dentist or facility nearby.
Questions?
We're here to help. Contact our Sales and Account Services team for friendly support.
Medical networks
Here are the medical provider networks for our Oregon small and large group members. Members save money by seeing in-network providers. Check medical plan summaries to see which medical network each small group plan includes.
Connexus Network
When clients want our broadest selection of providers across Oregon, Connexus Network has them covered. Clients located anywhere in Oregon can choose a plan with this network. Members can see in-network providers in all counties in Oregon and some areas in Washington and Idaho.
Coordinated Care Model (CCM) plans
Our CCM plans, powered by the Synergy network, offer patient-centered care with a team-based approach. The plans connect a primary care provider with the rest of a member's care team (other providers, specialists, etc.) to bring members the best treatments. By choosing a CCM plan, members will enjoy a team-based approach to healthcare, coordinated care across the healthcare system for better health outcomes, and a dedicated Primary Care Provider (PCP) that coordinates care. The CCM plan is the best option for members looking for partners to help them on their healthcare journey. This is also the ideal option for members who are managing an existing condition because of its laser focus on wellness, prevention and improving their quality of life.
Synergy Network
Groups located in Oregon can choose a plan with the Synergy network. The Synergy Network covers every county in Oregon. Members living or working in these areas can access care through the PCP they select.
Hospitals and health systems affiliated with the Synergy Network include:
- Adventist Health (OHSU partner)
- Asante
- Bay Area Hospital
- Blue Mountain Hospital District
- CHI St.Anthony Hospital
- Columbia Memorial Hospital
- Curry Health District
- Good Shepherd
- Grand Ronde Hospital
- Harney District Hospital
- Kadlec Regional Medical Center
- Lake Health District
- Legacy Health
- Lower Umpqua Hospital
- Mercy Medical Center
- Mid Columbia Medical Center
- Morrow County Health District
- Oregon Health & Science University (OHSU)
- PeaceHealth
- Salem Clinic
- Salem Health
- Samaritan Health Services
- Santiam Memorial Hospital
- Sky Lakes Medical Center
- Southern Coos Hospital and Health Center
- St.Alphonsus Medical Center
- St.Anthony Hospital
- St.Charles Health System
- St.Luke's Hospital
- Tuality Healthcare (OHSU partner)
- Wallowa Memorial Hospital
- Willamette Valley Medical Center
Networks outside of Oregon
Members living in states outside of Oregon can receive in-network care through the following networks.
First Choice Health Network
Members living in most counties in Washington can receive in-network care through First Choice Health Network. It includes thousands of doctors, hospitals and other medical providers across many specialties.
Private HealthCare Systems (PHCS) Network
Members living outside of Oregon or Washington in the U.S. can see providers in the PHCS Network for in-network care. It is the largest PPO medical network nationwide, with thousands of doctors and clinics, and hundreds of hospitals, to choose from. PHCS Network gives members plenty of choice.
First Health® Network
In 2021, we will be adding First Healthâ to our national network options for large group employers. With over 550,000 in-network providers and one million service locations nationwide, the First Health Network gives members access to quality care to manage their care and healthcare costs whether they are at home or on the road. To learn more, please work with your Moda Health Sales Rep when quoting new business to help your clients choose the right national network wrap for their employee population.
Travel network - First Health Network
When members hit the road, care is never far away. While traveling outside the network service areas, members can receive emergency or urgent care through the First Health Network which is paid at the in-network amount. Traveling for the purpose of seeking care does not qualify for the travel network benefit. Outside the U.S., members may access any provider for emergency care at the in-network cost-sharing amount. This care is subject to balance billing. Other care received outside the U.S. is not covered.
Questions?
We're here to help. Contact our Sales and Account Services team for friendly support.
Dental networks
Each Delta Dental of Oregon plan comes with a Delta Dental network. It includes thousands of dentists across the state, and the country.
To learn more about our dental networks go to DeltaDentalOR.com.
Questions?
We're here to help. Contact our Sales and Account Services team for friendly support.
Networks protect members, near and far
Health happens, whether employees are at home or on the road, so we've made it easy for them to find in-network coverage.
Each Moda Health medical plan and Delta Dental of Alaska plan comes with a provider network. Each medical network is a group of licensed health professionals, clinics, pharmacies, labs and hospitals located in a certain area. These providers offer quality care and services to Moda Health members at an agreed-upon cost. Each dental network includes network dentists who accept the Delta Dental contracted fee so there will be no additional balance billing.
View our networks:
In- and out-of-network care
It's important to remember that members may pay more for services from out of-network providers than from in-network providers. Out-of-network providers may balance bill members the difference between the maximum plan allowance and their billed charges.
Medical networks
Choose one in-state network to offer employees ‐ either Endeavor Select or Pioneer.
Endeavor Select
This Alaska network covers participating physicians, clinics and ancillary providers throughout the state. It includes Alaska Regional Hospital as the preferred provider of acute care services in the Anchorage area. Members can see First Choice PPO panel providers in Alaska for in-network care.
PHCS Network outside Alaska
For care outside Alaska, these members can see providers in the PHCS Network for in-network care. It is the largest PPO medical network nationwide, with thousands of doctors and clinics, and hundreds of hospitals to choose from. PHCS Network gives members plenty of choice and lower out-of-pocket costs.
Pioneer Network (for residents in the Municipality of Anchorage, Fairbanks North Star, Ketchikan Gateway, Kenai Peninsula, Mat-Su Boroughs and Prince of Wales-Hyder Census Area)
The Pioneer Network was developed to provide cost-effective, coordinated care. Pioneer offers three benefit levels (tiers) of healthcare:
- Tier One – Includes Central Peninsula Hospital, Alaska Regional Hospital, PeaceHealth Ketchikan Medical Center, Bartlett Regional Hospital, Mat-Su Regional Medical Center, South Peninsula Hospital and other Tier One contracted providers.
- Tier Two – It includes the First Choice Network in Alaska.
- Tier Three – All other Alaska providers not in Tier One or Tier Two.
Members can use any professional provider or hospital. However, Tier Three providers can balance bill. Members receive the best benefit by using Tier One providers.
First Health Network outside Alaska
Services received outside Alaska are covered at the Tier One benefit level for urgent and emergency care through providers in the First Health Network. Care outside of Alaska is not covered except for:
- Emergency services
- Coverage through medical travel support
- Coverage through out-of-state contracted providers
- Medically necessary non-emergency services that are prior-authorized by Moda Health
First Health® Network
In 2021, we will be adding First Healthâ to our national network options for large group employers. With over 550,000 in-network providers and one million service locations nationwide, the First Health Network gives members access to quality care to manage their care and healthcare costs whether they are at home or on the road. To learn more, please work with your Moda Health Sales Rep when quoting new business to help your clients choose the right national network wrap for their employee population.
Is a provider in-network?
Members can find out by visiting modahealth.com and using Find Care. They choose a network and look for a doctor, dentist or facility nearby.
Dental networks
Each Delta Dental of Alaska plan comes with a Delta Dental network. It includes thousands of dentists across the state, and the country.
To learn more about our dental networks go to DeltaDentalAK.com,
Questions?
We're here to help. Contact our Sales and Account Services team for friendly support.
Networks protect members, near and far
Each Moda Health medical plan and Delta Dental Plan of Oregon plan comes with a provider network. This is a group of licensed health professionals, clinics, pharmacies, labs and hospitals located in a certain area.
View our networks:
In-network care offers better value
Members get a better benefit and can save money by seeing in-network providers. These providers offer quality care and services to our members at an agreed-upon cost.
Care from out-of-network providers may also be subject to "balance billing" - the difference between what the plan allows or reimburses and the providers' billed charges. In-network providers don't do this.
Is a provider in-network?
Members can find out by visiting modahealth.com and using Find Care. They choose a network and look for a doctor, dentist or facility nearby.
Questions?
We're here to help. Contact our Sales and Account Services team for friendly support.
2018 medical networks
Here are the 2018 medical provider networks for our Oregon small group members. Members save money by seeing in-network providers. Check medical plan summaries to see which medical network each plan includes.
Connexus Network
This is one of the largest preferred provider organization (PPO) medical networks in Oregon. It includes thousands of primary care providers and specialists working together with Moda Health to help keep members healthy. Groups located anywhere in Oregon can choose a plan with this network. Members can see in-network providers in all counties in Oregon and some areas in Washington and Idaho.
Synergy Network
Groups located in the Portland metro, SW Washington, Salem, Eugene or parts of the Oregon north coast or Columbia River Gorge communities can choose a plan with this network. Members living or working in these areas can access care through the nearby medical home they select.
Hospitals and health systems affiliated with the Synergy Network include:
- Adventist Health
- Asante
- Columbia Memorial Hospital
- Legacy Health
- Legacy Silverton Hospital
- Mid-Columbia Medical Center
- Oregon Health Science University (OHSU)
- PeaceHealth
- Salem Health Hospitals and Clinics
- Samaritan Health Services
- Santiam Hospital
- Sky Lakes Medical Center (affiliated with OHSU)
- St. Charles Health System
- Tillamook Regional Medical Center
- Tuality Healthcare (Partners with OHSU)
Synergy Network covers these counties:
Benton, Clackamas, Clatsop, Columbia, Crook, Coos, Curry, Deschutes, Douglas, Hood River, Jackson, Jefferson, Josephine, Klamath, Lane, Lincoln, Linn, Marion, Multnomah, Polk, Tillamook, Wasco, Washington and Yamhill counties.
Summit Network
Groups located in eastern Oregon can choose a plan with this network. Members living or working in this area can access care through the nearby medical home they select.
Hospitals and health systems affiliated with the Summit Network include:
- Blue Mountain Hospital District
- CHI St. Anthony Hospital
- Good Shepard Health Care System
- Grande Ronde Hospital
- Harney District Hospital
- Kadlec Health System
- Lake Health District
- Morrow County Health District
- Saint Alphonsus Health System
- Trios Health
- Walla Walla Clinic
- Wallowa County Memorial Hospital
Summit Network covers these counties:
Baker, Gilliam, Grant, Harney, Lake, Malheur, Morrow, Sherman, Umatilla, Union, Wallowa and Wheeler.
Medical homes make care personal
Members can find out more information about Medical Home by visiting modahealth.com/medicalhome.
Networks outside of Oregon
All Oregon small group plans have access to these provider networks. Members must meet the criteria described here to see these providers for in-network care.
First Choice Health Network
Members living in most counties in Washington can receive in-network care through First Choice Health Network. It includes thousands of doctors, hospitals and other medical providers across many specialties. To find on First Choice Health providers, members visit fchn.com and choose the link to find a doctor, hospital or facility.
Travel network - First Health Network
When members hit the road, care is never far. First Health Network is one of the largest preferred provider organization (PPO) medical networks in the United States. Members have access to more than a million participating providers and more than 5,000 hospitals nationwide, giving them plenty of choice and lower out-of-pocket costs.
When traveling outside the network service areas, members can receive emergency or urgent care through the First Health Network, which is paid at the in-network amount. The travel network is only for emergency care or urgent services while traveling — it is not for the purpose of seeking medical card outside of their established network.
Questions?
We're here to help. Contact our Sales and Account Services team for friendly support.
2018 dental networks
Each Delta Dental of Oregon plan comes with a Delta Dental network. It includes thousands of dentists across the state, and the country.
Depending on the plan type, members access dentists in the Delta Dental Premier or PPO network. Members save money by seeing participating, in-network dentists.
Here are the 2016 dental provider networks for our Oregon small group members. Check dental plan summaries to see which dental network each plan includes.
Delta Dental Premier® Network
This is the largest dental network in Oregon and across the country. It includes more than 2,400 providers in Oregon and over 153,000 Delta Dental Premier dentists nationwide.
Delta Dental PPO NetworkSM
This is one of the largest preferred provider organization (PPO) dental networks in Oregon and across the country. It includes more than 1,300 participating providers in Oregon and offers access to over 105,000 Delta Dental PPO dentists nationwide.
Questions?
We're here to help. Contact our Sales and Account Services team for friendly support.
Networks protect members, near and far
Each Moda Health medical plan and Delta Dental of Alaska plan comes with a provider network. This is a group of licensed health professionals, clinics, pharmacies, labs and hospitals located in a certain area.
View our networks:
In-network care offers better value
Members get a better benefit and can save money by seeing in-network providers. These providers offer quality care and services to our members at an agreed-upon cost.
Care from out-of-network providers may also be subject to "balance billing" - the difference between what the plan allows or reimburses and the providers' billed charges. In-network providers don't do this.
2018 medical networks
Our Alaska medical networks differ only by the Anchorage-area hospital they include. Within Anchorage, members must use the in-network hospital for covered care. Outside the Anchorage area and within Alaska, members can use any hospital for in-network coverage.
For other care inside Alaska, members can see any professional provider and receive the in-network benefit level. However, out-of-network providers can balance bill. Members get the best benefit by seeing Beech Street PPO providers in Alaska.
Outside Alaska, members can receive in-network care from physicians, ancillary providers, clinics and hospital through the PHCS Network.
Here are the 2018 medical provider networks for our Alaska small group members. Members save money by seeing in-network providers. Check medical plan summaries to see which medical network each plan includes.
Endeavor Providence
This Alaska medical network covers participating physicians, clinics and ancillary providers throughout the state. It includes Providence Alaska Medical Center as the preferred provider of acute care services in the Anchorage area. Members can see Beech Street providers for in-network medical care anywhere in Alaska.
Endeavor Select
This Alaska medical network covers participating physicians, clinics and ancillary providers throughout the state. It includes Alaska Regional Hospital as the preferred provider of acute care services in the Anchorage area. Members can see Beech Street providers for in-network medical care anywhere in Alaska.
PHCS Network outside Alaska
Outside Alaska, members can see PHCS Network providers for in-network medical care. It is the largest preferred provider organization (PPO) medical network nationwide. Members have access to more than 130,000 practitioners, 7,500 clinics and 300 hospitals. PHCS Network gives members plenty of choice and low out-of-pocket costs.
Beech Street providers
Both Endeavor Providence and Endeavor Select medical networks connect members with Beech Street, a MultiPlan network. By seeing a Beech Street Network provider in Alaska, members can enjoy lower out-of-pocket costs and no balance billing for services that are paid.
Is a provider in-network?
Members can find out by visiting modahealth.com and using Find Care. They choose a network and look for a doctor, dentist or facility nearby.
2018 dental networks
Each Delta Dental of Alaska plan comes with a Delta Dental network. It includes thousands of dentists across the state, and the country.
Depending on the plan type, members access dentists in the Delta Dental Premier or PPO network. Members save money by seeing participating, in-network dentists.
Here are the 2018 dental provider networks for our Alaska small group members. Check dental plan summaries to see which dental network each plan includes.
Delta Dental Premier® Network
This is the largest dental network in Alaska and nationally. It includes four out of every five providers in Alaska and over 153,000 Delta Dental Premier Dentists nationwide, serving 50 states, the District of Columbia and Puerto Rico.
Delta Dental PPO Networksm
The preferred provider option (PPO) dental network for residents of Anchorage and the Mat-Su Valley includes over 170 participating providers and offers access to over 104,000 Delta Dental PPO Dentists nationwide.
Questions?
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Hello.
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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