SHP Introduces New Provider Dispute Process November 20, 2024 Samaritan Health Plans has streamlined the process for resolving provider disputes. Effective immediately, providers wishing to dispute a claim should submit a Provider Dispute Form (English) by mail to SHP. This new form can be printed from our website at samhealthplans.org/providers/forms. Disputes are handled outside of the appeals process. A provider may file a dispute for claims-related issues such as: Benefits (coverages and maximums). Eligibility. Provider contract disputes. Timely filing. Reimbursement (DRG/APC/Outliers, payment modifiers, other payment issues). Coordination of benefits. Coding issues – such as CCI bundling edits, CES edits and frequency edits. A Provider dispute is NOT related to: Initial utilization review (preauthorization). Post service authorization/denials. Initial claim decision based on medical necessity or experimental/investigation coverage criteria. Provider disputes from contracted providers should be submitted within 365 days of the claim remittance and do not require member consent. Please allow up to 60 days for the dispute to be reviewed.Non-contracted providers should follow the appeals process. Send the Provider Dispute Form and all necessary documentation to the health plan of which your patient is a member: InterCommunity Health Network CCO PO Box 887 Corvallis, OR 97339 Samaritan Choice Plans PO Box 336 Corvallis, OR 97339 Samaritan Employer Group PO Box 887 Corvallis, OR 97339 Samaritan Advantage Health Plans PO Box 1510 Corvallis, OR 97339 Any questions should be directed to our Customer Service team at 541-768-4550 or toll free at 800-832-4580. Customer Service is available from 8 a.m. to 8 p.m.
