In-patient procedures support

Urgent / Emergent Hospital Admissions

Notify Moda Health within 48 hours of all urgent/emergent admission
Phone: 888-474-8540 or 800-258-2037
Fax: 800-522-7004 

Skilled Nursing Facility Admissions

Contact Healthcare Services for skilled nursing facility admissions
Phone: 888-474-8540 or 800-258-2037
Fax: 800-522-7004  

Elective inpatient procedures

1. Prior authorization is required for all inpatient admissions. Failure to obtain authorization may result in non-payment of claim and provider liability. Members may not be balance billed.
2. Before requesting authorization, verify member's eligibility and benefits by logging in to Benefit Tracker
3. Verify that the requested provider or facility is in-network via our provider search  
4. Moda Health Medical Necessity Criteria, MCG guidelines, or CMS guidelines may be used for coverage determination.
5. Verify member network availability and any contract specific prior authorization requirements by logging in to Benefit Tracker
6. Prior authorization of a service or procedure does not guarantee payment.