- Samaritan Health Plans
- Providers
- Physical Health Providers
Physical Health Providers
building healthier communities.
We hope these resources are helpful.
Welcome Providers
We view health care as a team effort, with you as our partner in improving the health of our members.
Provider Relations is here to make things simpler by being a trusted contact and providing you with:- Comprehensive tools and resources.
- Provider education information.
- Support for your provider portal.
- A place for you to give feedback.
Feel confident knowing you have a team in your corner, dedicated to finding solutions — working together with you!
Contact Provider Relations at SHPprovider@samhealth.org.
Make PCP Changes Online
Introducing PCP Assignment — a new tool through Provider Connect for PCPs who have patients that are members of InterCommunity Health Network Coordinated Care Organization (IHN-CCO) and Samaritan Advantage. With PCP Assignment, providers can manage and maintain accurate member assignments, access daily reports and updates in real-time, and track all assignment activities.
Resources
Watch the presentations from our educational Alternative Payment Methodologies Forum in Lebanon.
The following keynote speakers each shared how they have achieved the 5-star designation:
- Sherlyn Dahl, Executive Director — Community Health Centers of Benton & Linn Counties
- Megan Van Vleet, Clinic Operations Manager — Samaritan Pediatrics and Samaritan Health Services Center for Healthcare Communication
Learn how Patient-Centered Primary Care Homes have resulted in better patient health outcomes and lower costs for all Oregonians.
What Is Risk Adjustment?
Risk adjustment is defined by healthcare.gov as a statistical process that takes in to account the underlying health issues and health spending of the enrollees in an insurance plan when looking at their health care outcomes or health care costs. In other words, risk adjustment focuses on the accurate capture of a person’s demographics, health conditions and health status, which ensures the health plan receives the compensation it needs to effectively support and keep its members healthy.
The Medicare Advantage risk adjustment process is regulated by the Centers for Medicare & Medicaid Services and uses the Hierarchical Condition Categories (HCCs) risk model to estimate future health care costs. The CMS HCC model includes chronic conditions as well as some serious acute conditions. There are more than 75 HCCs that map to approximately 9,000 ICD-10 codes. These HCCs in addition to demographic factors, like age and gender, make up a person’s risk score, also known as their Risk Adjustment Factor (RAF).
Why Should You Care About Risk Adjustment?
Risk adjustment gives better insight into a person’s health risks and needs. A Medicare Advantage member’s risk score resets with CMS each year on January 1, which is why it’s important to not only see, but also document a person’s risk conditions every year. Accurate documentation leads to accurate risk scores, which results in accurate payments to the health plan. This ultimately allows Samaritan Health Plans to maximize care for its members through various programs and support.
Samaritan Health Plans works closely with providers on its risk adjustment efforts. A couple of those efforts include retrospective chart reviews and ongoing monitoring, which consist of validating medical records throughout the year to ensure accurate payment.
Where Can I Find More Risk Adjustment Information?
Documenting For Risk Adjustment
Morbid Obesity - Coding & Documentation
Substance Use Disorders - Coding & Documentation
Additional Resources
Medicare Advantage Risk Adjustment | CMS
Justice News | DOJ | Department of Justice
Other questions? Contact Risk Adjustment at SHPRiskAdjustment@samhealth.org