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Review Credentialing Requirements

 All interested health care professionals and facilities are required to be credentialed prior to contracting with Samaritan Health Plans.

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 541-768-4550, Mon. - Fri., 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 541-768-4550, Mon. - Fri., 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

Talk with our Provider Services representatives 

call us at 541-768-5207
1-888-435-2396
8 a.m. to 5 p.m.
Mon. - Fri.