- Samaritan Health Plans
- Providers
- Care Management
- Authorizations
Medical & Pharmacy Authorizations
Medical Authorizations
The Utilization Management team manages authorization requests made on behalf of our members. This includes medical, surgical, mental health and addiction medicine requests for inpatient, rehabilitation, DME and other specialty services requiring an authorization for the plan.
Samaritan Health Plans will not review any retroactive requests for medical necessity unless the request meets certain exceptions outlined in our Prior Authorization FAQ.
IHN-CCO Utilization Management & Service Authorization Handbook
Utilization management (UM) is integrated within the Medical Management care management program. This handbook is designed to assist in understanding the prior authorization review process: types of reviews performed, specific criteria applied, notification process, etc. Please access this handbook for more information and step-by-step instructions for submitting online prior authorization requests. Utilization Management & Service Authorization Handbook.
Request a Medical Authorization Electronically
Visit your provider portal to submit and track your authorizations online.
Pharmacy Authorizations
Provider Prescription Prior Authorization Requests
Select medications may require prior authorization. A physician may submit authorization requests by:
- Faxing the plan using the form below.
- Submit electronically using one of our partners below (CoverMyMeds or Surescripts).
You can call Customer Service for additional questions at 541-768-5207 or toll free at 888-435-2396.
Prescription Prior Authorization FormSubmit Authorization to CoverMyMedsSubmit Authorization to Surescripts
Understand Appeal Guidelines
Specific circumstances allow a provider to appeal for a medical, pharmacy, or durable medical equipment (DME) authorization or payment denial on behalf of a patient.
Prior Authorization Lists & Forms
Services or items requiring an authorization are identified in the plan documents and listed here by plan.