- Samaritan Health Plans
- Providers
- Care Management
- Authorizations
Authorizations
Update
During this time of constrained hospital resources, Samaritan Health Plans and InterCommunity Health Network (IHN-CCO) are waiving authorizations for the initial seven days at skilled nursing facilities, inpatient rehab and long term acute care hospitals effective Dec. 15, 2021 through March 15, 2022.
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 an Authorization Electronically
Visit your provider portal to submit and track your authorizations online.
Understand Authorization 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.
Providers Can Request Prescription Prior Authorization
Select medications may require prior authorization. A physician may request authorization.
How to Request Prior AuthorizationPrescription Prior Authorization FormSubmit Electronic Prior Authorization