Non-contracted Appeals

Non-contracted providers follow the following process for appeals to Samaritan Advantage Health Plan:

Non-contracted providers have the right to request a reconsideration of the plan’s denial of payment.
Non-contracted providers have 60 calendar days from the remittance notification date to file the reconsideration.
Non-contracted providers must include the Appeal Request for Samaritan Advantage and signed Waiver of Liability form holding the enrollee harmless regardless of the outcome of the appeal.
Non-contracted providers should include documentation such as a copy of the original claim, remittance notification showing the denial, and any clinical records and other documentation that supports the provider’s argument for reimbursement.
Non-contracted providers must mail the reconsideration to the plan at: Samaritan Advantage Health Plan, PO Box 1510, Corvallis, OR 97339

Appeals for Non-contracted Providers