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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. 

Samaritan Health Plans will not review any retroactive requests for medical necessity unless the request meets certain exceptions outlined in our Prior Authorization FAQ.

Medical Management Plan

The Medical Management Plan describes the Medical Management program structure, scope and department objectives. The Plan provides a current overview of the individuals, programs, project components and activities in place to monitor and improve the delivery of health care services contained within the oversight of the Medical Management program. Medical Management Plan

IHN-CCO Utilization Management & Service Authorization Handbook

Utilization management (UM) is integrated within the Medical Management care management program. This handbook is designed to assist in understanding the prior authorization review process: types of reviews performed, specific criteria applied, notification process, etc. Please access this handbook for more information and step-by-step instructions for submitting online prior authorization requests. Utilization Management & Service Authorization Handbook

Request an Authorization Electronically

Visit your provider portal to submit and track your authorizations online.

Request Rx Prior Authorization

Select medications may require prior authorization. A physician or member may request authorization.