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Prior Authorization Lists and Forms

The Utilization Management team manages authorization requests made on behalf of our members. This includes medical, surgical, mental health and addiction medicine requests for inpatient, rehabilitation, DME and other specialty services requiring an authorization for the plan. Services or items requiring an authorization are identified in the plan documents and listed here by plan. Authorizations are processed as standard (14 business days) or expedited (72 hours from receipt of request). 

You Can Request an Authorization Electronically

Visit your provider portal, Provider Connect, to submit and track your authorizations online.

Samaritan Standard, Health & Well-Being, Momentum, New Performance, and Everyday Choices

Talk with our Provider Services representatives 

call us at 541-768-5207 1-888-435-2396 8 a.m. to 6 p.m.
Mon. - Fri.