On Wednesday, Feb. 21, Samaritan Health Plans learned that Change Healthcare, Part of Optum, a vendor that processes medical insurance claims to payors, was experiencing a network interruption related to a cyber security issue. Health systems across the country have been impacted by the Change Healthcare cyber security incident.
To prevent any potential local impact on systems, Samaritan has temporarily disabled our connections with Change Healthcare technology platforms. As a result, there is currently some disruption to the prior authorization process, claims processing and pharmacy operations. We are unsure at this time how long this disruption may occur.
Please utilize Office Ally and Trizetto Provider Solutions when submitting claims.
Our customer service representatives can check eligibility and quote benefits, however, you will find our Provider Connect portal will save you time and be more convenient. The portal also allows you to view your claim status, submit prior authorization requests and check prior authorization status.
Even for claims billed under the First Choice Health or First Health networks, submit claims directly to Samaritan Health Plans to ensure prompt payment.
A corrected claim is any claim that has a change to a claim previously processed (e.g., changes or corrections to charges, procedure or diagnostic codes, dates of service, added lines, etc.). Electronically submitted claim corrections should be submitted in the following format:
1. In the 2300 Loop, the CLM segment (claim information), CLM05-3 (claim frequency type code) must indicate “7” – REPLACEMENT (replacement of prior claim).
2. In the 2300 Loop, a REF*F8 segment needs to follow the CLM segment (claim information) and must include the prior claim number issued by Samaritan Health Plans or IHN-CCO for the claim being corrected. Samaritan Health Plans and IHN-CCO claim numbers consist of 11 to 12 numeric characters and can be found on your electronic remittance advice (EDI 835), paper remittance advice or in the Provider Connect portal.
3. Any original claim lines that are removed and not resubmitted on the replacement claim will automatically be removed during reprocessing and the previously paid amount will be auto recouped from the next payment issued.
Samaritan Health Plans encourages you to file your claims electronically as a way to lower administrative expenses, receive payments more quickly, reduce paper use and expedite billing error corrections. We offer four options for electronic claims submission, also known as EDI:
CHC1 – Currently suspended due to cyber threat. We are tracking this situation and will lift this notice once the issues are resolved.changehealthcare.com800-527-8133, option 2Payer IDs: 2122 (Professional) and 5952 (Institutional)
Change Healthcare – Currently suspended due to cyber threat. We are tracking this situation and will lift this notice once the issues are resolved.changehealthcare.com866-371-9066Payer ID: CP001 (All plans)
Office Allyofficeally.com360-975-7000, option 1 — Customer Service Payer IDs: SAMHP (All plans)
Trizetto Provider SolutionsPhysicianSupport@cognizant.com800-969-3666 — Customer ServicePayer IDs: SAMAD (Samaritan Advantage), SAMCP (Samaritan Choice), INCHN (InterCommunity Health Network CCO), SAM00 (Samaritan Employer Group)
Submit paper claims via mail to these addresses:
InterCommunity Health Network CCOPO Box 887Corvallis, OR 97339
Samaritan Choice PlansPO Box 336Corvallis, OR 97339
Samaritan Employer Group PPO PlansPO Box 887Corvallis, OR 97339
Samaritan Advantage Health PlansPO Box 1510Corvallis, OR 97339
For claims that must be submitted on paper there are some simple things that providers can do to speed up processing and payment:
Need help filling out the CMS 1450 or 1500 Form? Use the following guides to find out what each field is for and which are always required.
The No Surprises Act of 2020, also known as NSA, created legislation to protect patients from surprise balance billing for defined out-of-network items and services such as:
It applies to Samaritan Small and Large Group Plans and Samaritan Choice Plans (self-insured), and is effective for plan or policy years beginning on or after Jan. 1, 2022. The protections of the law do not apply if the member chooses to receive items and services from an out-of-network health care provider (with some exceptions).
Use the Open Negotiation Notice form to initiate the No Surprises Act 30-day open negotiation period by emailing SHPprovider@samhealth.org, Attention: Contracting Department.
You must complete and return the Open Negotiation Notice form within 30 business days of the date of receipt of the initial payment.
Visit cms.gov for additional information on the No Surprise Act.
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Hours: Mon. – Fri., 8 a.m. to 8 p.m. PTIn Corvallis, call: 541-768-5207 Toll-free: 1-888-435-2396
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