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What Is Credentialing?
The credentialing process includes verification of education, experience, competence and licensure of health care providers.

Which Providers Need to Be Credentialed?
Most licensed providers will need to complete the Oregon Practitioner Credentialing Application (OPCA).

Which Providers Need to Be Validated?
The validation form is intended for unlicensed behavioral health providers and traditional health workers. If you are unsure which form to use, contact the Provider Relations team at shpprovider@samhealth.org. 

Are There Any Providers Who Do Not Need to Be Credentialed or Validated?
Yes. Most practitioners who practice exclusively within the hospital or inpatient setting are not required to be credentialed by Samaritan Health Plans. 

How Long Does Credentialing & Validation Take?
Credentialing and verifications can take up to 90 days from the date SHP receives a completed application.

What Does a Complete Credentialing Application Consist Of?
When completing the credentialing application, the following elements are required:

• Complete all sections on the form or mark N/A.
• Include all prior and current practice locations.
• Include identification numbers.
• Answer all questions and provide explanations, if needed.
• Provide copies of:
  * Curriculum vitae, including work history.
  * Professional license or DEA certificate.
  * Copy of malpractice insurance face sheet.
  * Summary of any pending or settled malpractice cases. 

I Submitted My Credentialing Application. What Happens Next?
The credentialing staff will begin processing your application and will contact you if there are any questions or if additional documentation is needed. Make sure your contact information is current to avoid unnecessary delays.

How Do I Know When My Credentialing Is Complete?
You will be notified by the credentialing staff confirming the credentialing process is complete.

Where Can I Find the Credentialing or Validation Application? 
Credentialing and validation forms can be found on the Samaritan Health Plans’ Provider website under the Join Our Network section.

Is There Anything I Can Do To Speed up the Credentialing Process?
Unnecessary delays can be avoided by completing the credentialing application accurately and including all required documents. Your application will not be processed until all required information is submitted. Review your application in detail before submitting it. Common issues are missing signatures or initials, not completing a section or missing documents.

How Often Do I Need to Be Credentialed?
Once you are credentialed, you will need to be re-credentialed every two to three years. Staff from the SHP Credentialing Department will contact you when it’s time to submit your application.

Where Do I Submit My Credentialing Application?
Completed applications and attachments can be emailed to: shscredentialinghealthplansoperation@samhealth.org.

Do You Have Any Tips for Making the Credentialing Process Smoother in the Future?
The credentialing process can be time-consuming but following these tips will assist with the organization of your application and documents.

• Start the credentialing process early. Remember, it can take 90 days from start to finish.
• Before submitting your credentialing paperwork, make sure to review it in its entirety to ensure every question is answered and each page is initialed and dated.
• Establish peer references. Your application must contain peer references so having those lined up can save you some last-minute stress.
• Maintain a list of expiration dates for licensing and credentials so you can be prepared in advance for when you need to submit renewal applications.
• Keep a digital file of your credentialing application and supporting documents. Keeping documents electronically and in one place will ease the preparation time when re-credentialing is required.
• Be responsive. It is common for the credentialing staff to contact you with questions or when additional documents are needed. Make sure you are available and respond in a timely manner to avoid delays.

Review and complete the following credentialing forms:

The Oregon Practitioner Credentialing Application

The Oregon Practitioner Recredentialing Application

Organizational Provider Credentialing Application

Medicaid Provider Validation Application

 For more information, please visit the OHA State Application page.

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 – 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 provide 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.

For more information, contact Samaritan Health Plans’ Provider Services at 888-435-2396 or 541-768-5207, Monday through Friday from 8:30 a.m. to 5 p.m. PT.

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

• Facility Credentialing Application – Required
• 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

For more information, contact Samaritan Health Plans’ Provider Services at 888-435-2396 or 541-768-5207Monday through Friday from 8:30 a.m. to 5 p.m. PT.

• 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

Effective Jan. 1, 2023, Samaritan Health Plans/InterCommunity Health Network Coordinated Care Organization pays for covered services provided to our members during the credentialing period at the in-network benefit and under the terms of the contract. For this to apply, the credentialing application must be approved by the carrier. Please do not bill for these services until AFTER your credentialing is approved. Claims submitted without approved credentialing will be denied and require resubmission after approval in order to receive payment.

Reimbursement would start on the date the completed credentialing application is received by the Credentialing Department or the effective date of the contract between the provider and SHP/IHN-CCO; whichever is later.

If the credentialing application is denied or there isn’t a contract in effect between the provider and SHP/IHN-CCO on the date of service, the services will be considered out-of-network and processed according to that benefit.