Take a moment to learn how you can speed up the process for prior authorizations, credentialing new providers, claims processing and more.
Speed Up Prior Authorizations
To improve the response time of authorization requests, Samaritan Health Plans encourages you to submits your prior authorizations electronically through Provider Connect. If you require assistance accessing Provider Connect, contact Provider Relations at SHPprovider@samhealth.org.
Contact SHP With Provider and Demographic Changes
All provider and demographic changes must be reported to Samaritan Health Plans within 30 days. Update your information electronically at provider.samhealthplans.org/Update-Your-Info to help us provide the most accurate information to our members.
Allow Time for Credentialing New Provider
Remember to allow 90 days from the time we receive a complete Oregon Practitioner Credentialing Application (OPCA) and supporting documents so the Credentialing Department can complete their process in order to add a new practitioner.
Help Us Process Claims Quickly and Accurately
For timely processing of claims, remember to use appropriate modifiers. The Oregon Health Authority Fee Schedule oregon.gov/oha/hsd/ohp/pages/fee-schedule is a great resource for more information about procedure codes and when modifiers are required.
Add Referring Provider to Claims is Required
For DME, lab and imaging claims, the referring provider is required to be submitted on the claim. Please review CFR 42 C.F.R § 455.410 and OAR 410–120–1260 to learn more about these requirements.
An Active Medicare/Medicaid ID is Required to Bill Claims
For Samaritan Advantage and InterCommunity Health Network CCO all ordering and referring providers must have an active Medicare/Medicaid ID. To implement and regulate this requirement, we will be updating our system to comply with Medicare and Medicaid regulations and begin denying claims not billed correctly as of September 1, 2020. To learn more about these requirements, review CFR 42 C.F.R § 455.410 and 410–120–1260.