On April 1, 2017, we will be replacing AIM Specialty Healthcare with utilization management programs for advanced imaging (cardiology, radiology, ultrasound) and musculoskeletal services (spine/joint surgery, spine/joint pain management and alternative care) with eviCore healthcare.
This change impacts how providers request and obtain prior authorizations for medical services.
Please note: if a member sees a provider who is out of network it may lead to higher out-of-pocket costs. The member cost will vary based on the following conditions:
Utilization management (UM) includes medical reviews for services that require prior authorization. Following evidence-based care guidelines, UM helps ensure patients receive the highest quality of care and avoid paying more for unneeded services or treatments. While the adoption of evidence-based care protocols remains an industry challenge, UM supports medically appropriate care through responsible decision-making and better cost management.
Our partnership with eviCore is focused on providing patients with the highest quality of care at the lowest cost. With eviCore's streamlined prior authorization process, your clients get cost-effective, quality care when they need it.
We're here to help. Please contact your sales representative or account services representative.
To learn more about Moda's prior authorization services through eviCore, please see our FAQ.
Tell us you're interested and we'll be in touch with details.
If you can't find an answer, please feel free to contact our Customer Service
For value-based provider programs, including Synergy, Summit, Beacon, Affinity, CPC+, and EOCCO
Check benefits, eligibility, incentive and utilization
If you are creating an account for an adult member of your family, that member must have given you permission to set up an account in his/her behalf. If permission has not been provided, you may be violating the privacy of that individual's information.
I have read and acknowledge this and would like to proceed.
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.
Please select the state you live in, or the state where your employer is headquartered, so we can tailor your experience:
You can return to your previous location in the site header.