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.

Provider Connect

Pharmacy Authorizations

Samaritan Health Plans Pharmacy Services and OptumRX manages prescription authorization requests submitted on behalf of members. Prescription drugs provided by a pharmacy may require authorization for coverage. Please review drug lists and criteria to determine if a request is necessary. Providers who supply prescription drugs in their office should buy and bill through the medical benefit. 

Formulary & Drug Criteria

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.

Submit an Appeal

Prior Authorization Lists & Forms

Services or items requiring an authorization are identified in the plan documents and listed here by plan.