Contracts and Credentialing

Contracts and Credentialing

Welcome to Samaritan Health Plans. This page will assist you in finding out how to become a contracted provider and the benefits in contracting with Samaritan Health Plans. Thank you for taking the time to visit us.


Join our network

Interested in becoming a participating provider with Samaritan Health Plans? If so, please fill out the Letter of Interest (LOI) form and submit to:
Samaritan Health Plans
Provider Services Dept.                 OR           Fax to: (541) 768-4513
815 NW Ninth Street, Suite 101
Corvallis, OR  97330

Your information will be personally handled by one of our Provider Services Staff experts to review. Samaritan Health Plans will contact you within five business days of receipt of your information.

All interested health care professionals and facilities are required to be credentialed prior to contracting with Samaritan Health Plans.


Updating your information

C H A N G E S
If any of your practice information has changed such as TIN, practice location, change in ownership, etc., please fill out the following form and submit via facsimile to Attn: Provider Services Dept (541) 768-4513.
Demographic Change form

A D D I T I O N S
If you are adding a new practitioner and/or locum practitioner to your group, please fill out the New and Locum Provider Notice form and submit via facsimile to Attn Provider Services Dept (541) 768-4513.

If you would like to add information regarding your CMS PCP qualification status by attesting that you meet the criteria as defined in the ACA Section 1202, please complete an IHN-CCO PCP Attestation Form and submit via Fax. Instructions are included on the form.

D E L E T I O N S
If a practitioner is leaving your group, please fill out the Termed Provider Notice form and submit via facsimile to Attn: Provider Services Dept (541) 768-4513.

Please allow five business days for your changes to take effect.


Meeting our credentialing requirements

Contracting is contingent on credentialing approval. Samaritan Health Plans follows CMS and NCQA requirement for credentialing providers. The following is a listing of information that Samaritan Health Plans needs in order to credential practitioners and other health care professionals:

  • Oregon Practitioners Credentialing Application http://www.oregon.gov/oha/OHPR/ACPCI/pages/state_app.aspx. – Required
  • Completed and signed Attestation & Release – Required
  • Completed and signed Attachment A – Required (mark N/A if not applicable, sign & date)
  • Copy of current Oregon State License and/or Registration – Required
  • Current DEA certificate(s) – Required, if applicable
  • Copy of your current Liability Certificate – Required
  • List of all medical malpractice carriers for the past 5 years, including carrier name, address, policy number, limits, and any claims history information – Required
  • Copy of Board Certificate(s) – Preferred
  • Copy of PA Practice Description, and OMB Supervising Physician Approval letter – Required, if applicable
  • Copies of Medical School diploma, and/or completion certificates from medical training – Preferred
  • Copies of Internship and Residency completion certificates – Preferred

Note: Your Credentialing Application will not be processed until all required documents are received, and your application is considered complete.

Exceptions: Providers who practice exclusively in an inpatient setting and who provider care to Samaritan Health Plan members’ as a result of the member being directed to the hospital or other inpatient setting are not required to be credentialed by Samaritan Health Plans.

The following is a listing of information Samaritan Health Plans needs in order to credential facilities:

  • Facility Credentialing ApplicationRequired

  • Completed and signed Attestation & Release – Required

  • W9 form

  • DEA – if applicable

  • Copy of Medicare and/or Medicaid certification – if applicable

  • Copy of current State License – Required

  • Copy of your current Liability Certificate – Required

  • Copy of Certification from an accredited agency – Required


Listing of providers who are eligible:

  • Acupuncturists

  • Ambulatory Surgery Center

  • Audiologist

  • Certified Nurse Midwife

  • Certified Registered Nurse Anesthetist

  • Chiropractor

  • Clinical Laboratories

  • Dialysis Facility

  • Doctor of Osteopathy

  • Durable Medical Equipment

  • Home Health

  • Home Infusion Therapy

  • Hospice

  • Hospital

  • Licensed Clinical Social Worker

  • Licensed Marriage & Family Therapist

  • Licensed Professional Counselor

  • Medical Doctor

  • Nurse Practitioner

  • Occupational Therapist

  • Optometrist

  • Oral Surgeon

  • Physical Therapist

  • Physician Assistant

  • Podiatrist

  • Psychiatric Nurse Practitioners

  • Psychologist

  • Registered Dietician

  • Skilled Nursing Facility

  • Speech Therapist