Use Proper Format for Electronic Corrected Claims

A corrected claim is any claim that has a change to a claim previously processed (e.g., changes or corrections to charges, procedure or diagnostic codes, dates of service, added lines, etc.). Electronically submitted claim corrections should be submitted in the following format:

1.  In the 2300 Loop, the CLM segment (claim information), CLM05-3 (claim frequency type code) must indicate “7” – REPLACEMENT (replacement of prior claim).

2.  In the 2300 Loop, a REF*F8 segment needs to follow the CLM segment (claim information) and must include the prior claim number issued by Samaritan Health Plans or IHN-CCO for the claim being corrected. Samaritan Health Plans and IHN-CCO claim numbers consist of 11 to 12 numeric characters and can be found on your electronic remittance advice (EDI 835), paper remittance advice or in the Provider Connect portal.

3.  Any original claim lines that are removed and not resubmitted on the replacement claim will automatically be removed during reprocessing and the previously paid amount will be auto recouped from the next payment issued.

Receive Payment More Quickly

Samaritan Health Plans encourages you to file your claims electronically as a way to lower administrative expenses, receive payments more quickly, reduce paper use and expedite billing error corrections. We offer four options for electronic claims submission, also known as EDI:

Change Healthcare Relay Exchange (formerly CHC1)
changehealthcare.com
800-527-8133, option 2
Payer IDs: 2122 (Professional) and 5952 (Institutional)

Change Healthcare – Currently suspended due to cyber threat. We are tracking this situation and will lift this notice once the issues are resolved.
changehealthcare.com
866-371-9066
Payer ID: CP001 (All plans)

Office Ally
officeally.com
360-975-7000, option 1 — Customer Service 
Payer IDs: SAMHP (All plans)

Trizetto Provider Solutions
trizettoprovider.com
[email protected]
800-969-3666 — Customer Service
Payer IDs: SAMAD (Samaritan Advantage), SAMCP (Samaritan Choice), INCHN (InterCommunity Health Network CCO), SAM00 (Samaritan Employer Group)

We Accept Paper Claims

Submit paper claims via mail to these addresses:

InterCommunity Health Network CCO
PO Box 887
Corvallis, OR 97339

Samaritan Choice Plans
PO Box 336
Corvallis, OR 97339

Samaritan Employer Group PPO Plans
PO Box 887
Corvallis, OR 97339

Samaritan Advantage Health Plans
PO Box 1510
Corvallis, OR 97339

Paper Claim Processing Tips

For claims that must be submitted on paper there are some simple things that providers can do to speed up processing and payment:

• Use only standard red and white CMS 1500 (HCFA) and 1450 (UB) forms.
• Submit only claim forms that are typed or printed.
• Print with dark font (i.e. do not print claims when toner/ink is low).
• Correctly align text in the form boxes and do not allow text to lap over lines.  
• All claims and attachments should be printed single sided.  Do not duplex print, even on primary EOBs or attachments.
• Send full page attachments only.
• Do not staple claims or attachments together.
• Mark multipage claims with either a page number (i.e. page 2 of 3) or a “continued”.
• Ensure that each secondary claim has the primary EOB submitted with it.
• Do not write or stamp over top of the body of the claim form.

CMS 1450 and 1500 Form Requirements

Need help filling out the CMS 1450 or 1500 Form? Use the following guides to find out what each field is for and which are always required.

• CMS 1450 Form Guide
• CMS 1500 Form Guide

The No Surprises Act of 2020, also known as NSA, created legislation to protect patients from surprise balance billing for defined out-of-network items and services such as: 

• Emergency services at out-of-network hospitals and free-standing emergency facilities.
• Out-of-network health care professionals at in-network facilities.
• Out-of-network air ambulance carriers.

It applies to Samaritan Small and Large Group Plans and Samaritan Choice Plans (self-insured), and is effective for plan or policy years beginning on or after Jan. 1, 2022. The protections of the law do not apply if the member chooses to receive items and services from an out-of-network health care provider (with some exceptions).

Use the Open Negotiation Notice form to initiate the No Surprises Act 30-day open negotiation period by emailing [email protected], Attention: Contracting Department. 

You must complete and return the Open Negotiation Notice form within 30 business days of the date of receipt of the initial payment. 

Visit cms.gov for additional information on the No Surprise Act.