ResourcesSamaritan Ministries & Medical Professionals
Welcome to Samaritan Ministries' online reference for medical professionals. The following information describes how patients who are members of Samaritan Ministries International (SMI) should be billed, and how your office will be paid by the member.
Select relevant program:
Samaritan™ Given™
If the patient presents a membership card that resembles the following, use the information and instructions for Samaritan Given as described below:
General Program Information
Network
Samaritan Given (the program) does not have a network. You do not need to register with us in order to treat the patient.
No preauthorization, prior notification, or precertification to the provider is required.
Payment at Time of Service
The member is not required to make any payment at the time of service.
Billing
Please bill the member electronically to EDI #: SM325. This is the most expedient way for you to be paid.
If you cannot find our EDI number in your system, please submit a request to your clearinghouse to add EDI #: SM325.
In the meantime, you can submit the bill directly to Samaritan Ministries' EDI clearinghouse, Smart Data Solutions.
If you are not able to bill via EDI, please submit the appropriate CMS form - either HCFA (CMS 1500) or UB-04 (CMS 1450) - to the following address:
Samaritan Given PO Box 3440 Peoria, IL 61612
If you need a CMS form, you may download it using one of the following links:
HCFA (CMS1500) for physicians [Instructions]
UB-04 (CMS1450) for hospitals/facilities [Instructions]
NOTE: The document links are posted here as a courtesy to the provider. They are not hosted by SMI, and SMI is not responsible for the content of these links.
The deadline for filing the bill is one year from the date of service. However, we recommend that bills be submitted as soon as possible in order to ensure the fastest payment turnaround possible.
Annual Unshareable Amount (AUA) and Co-Share
Members participating in Samaritan Given do not have premiums or coinsurance. However, there are thresholds the member must meet prior to receiving shared funds from other members. These amounts apply per household and are reset annually.
Annual Unshareable Amount (AUA): the total repriced charges that must be submitted annually before sharing portions are assigned to meet medical expenses.
Co-Share: the percentage of eligible charges that are not shared once the AUA has been met (until the max co-share is reached).
Members participating in Samaritan Given select one of the following sharing levels:
Given™ 10 ($1,000 AUA; 10% co-share; $2,500 max co-share)
Given™ 15 ($2,000 AUA; 15% co-share; $3,750 max co-share)
Given™ 20 ($5,000 AUA; 20% co-share; $5,000 max co-share)
Payment
The member receives money from other members, and then the member pays the provider according to the sharing guidelines of the program. Samaritan Ministries facilitates the member’s electronic payment to the provider.
Where does the money come from? Members make a monthly deposit to their virtual sharing wallet. Each week, members send funds electronically from their sharing wallet to one another in order to help pay for eligible medical bills.
Once a member with a bill receives the shareable amount from other members, both payment and a Remittance Advice are forwarded to the provider on the member's behalf.
How does my office receive payment? The shareable amount will be paid to the provider electronically, or by check if the provider does not accept electronic payments. Any remaining amount owed by the patient will be detailed in the Remittance Advice included with the payment.
In most cases, the payment will be sent within 2-7 weeks from the time the bill was received by Samaritan Ministries.
Learn more about the program in the Guidelines for Samaritan Given.
Fair and Reasonable Pricing
Samaritan Given does not have a fee schedule or allowed amounts, but there are permitted sharing amounts. Samaritan Ministries will limit the sharing of charges determined to be unfair or unreasonable and will advocate on behalf of sharing members against any health care provider demanding payment of unfair charges.
According to Section IX.I. of the Guidelines for Samaritan Given, Samaritan Ministries can refuse to facilitate the payment of unfair charges and of unreasonable charges, "based upon techniques, criteria, and standards adopted by SMI."
Permitted Sharing Amount(s) means charges for medical care, which is medically necessary for the care and treatment of illness or injury, but only to the extent that the fees charged therefore are within all applicable limitations and restrictions established in this program including, but not limited to, the following:
(a) Hospitals. For charges by hospitals other than independent facilities and ambulatory surgical centers:
(i) Inpatient Services. The Permitted Sharing Amount for medical care shared by the program shall be based upon the average of 150% of the Medicare allowable amount for the medical care shared by the program and 135% of the cost of the medical care shared by the program; provided, however, that any such Permitted Sharing Amount based on the cost of the medical care shared by the program shall be limited to an amount not to exceed 175% of the Medicare allowable amount or the amount of usual, customary, and reasonable fees for the medical care shared by the program.
(ii) Outpatient Services. The Permitted Sharing Amount for Outpatient medical care shared by the program shall be based upon the average of 150% of the Medicare allowable amount for the medical care shared by the program and 135% of the cost of the medical care shared by the program; provided, however, that any such Permitted Sharing Amount based on the cost of the medical care shared by the program shall be limited to an amount not to exceed 175% of the Medicare allowable amount or the amount of usual, customary, and reasonable fees for the medical care shared by the program.
(b) Ambulatory Surgery Centers & Independent Facilities. For charges by ambulatory surgery centers and independent facilities:
(i) The Permitted Sharing Amount for medical care shared by the program provided by ambulatory health care centers and other Independent Facilities, billed as ambulatory surgery centers, shall be based upon the average of 150% of the Medicare allowable amount for the medical care shared by the program and 135% of the cost of the medical care shared by the program; provided, however, that any such Permitted Sharing Amount based on the cost of the medical care shared by the program shall be limited to an amount not to exceed 175% of the Medicare allowable amount or the amount of usual, customary, and reasonable fees for the medical care shared by the program.
(c) Other Medical & Surgical Services. The Permitted Sharing Amount for any general medical and/or surgical medical care shared by the program not addressed under the two immediately preceding subsections or subsection (e) below may be established or calculated taking into consideration and/or based upon the average of:
(i) allowable reimbursement amounts for such medical care shared by the program according to the OPPS reimbursement or other Medicare fee payment methodology plus an additional 50%;
(ii) the costs for such medical care shared by the program plus an additional 35%; or
(iii) the usual, customary, and reasonable fees as reflected in, or determined by reference to or through the use of any other industry-standard resources or widely recognized data sources, including any resources listed above or any other fee and/or cost information, sources, lists or comparative data published or publicly available (free, for purchase or by subscription), or any combination of such resources that are sufficient, in the opinion of the Bills Delegate, to determine a reasonable amount of medical care shared by the program.
(d) Facilities lacking requisite benchmarks & specified services. In the event that for technical reasons Permitted Sharing Amounts for medical care shared by the program cannot be determined in accordance with the guidelines set forth above in the three immediately preceding subsections, and for other medical care shared by the program specified below, the Permitted Sharing Amounts may be determined as follows:
(i) Pharmaceuticals. The Permitted Sharing Amount for pharmacy charges from any hospital or independent facility may be calculated based on pharmaceutical costs, as follows:
a. 150% of cost for pharmaceuticals other than high dollar drugs, but not to exceed the usual, customary, and reasonable fees for such pharmaceuticals; or
b. 120% of cost for high dollar drugs; but not to exceed the usual, customary, and reasonable fees for such pharmaceuticals.
(ii) Supplies, Implants & Devices. The Permitted Sharing Amount for charges for medical and surgical supplies, implants and devices may be based upon 120% of the cost to the hospital or independent facility providing such items.
(e) Professional Bills. The Permitted Sharing Amounts for professional Bills services shall be determined based upon the charts linked below for the professional service identified.
(f) Dialysis Services and Infusion Therapy. The Permitted Sharing Amount for dialysis services and infusion therapy visits (which shall include dialysis, facility services, supplies and medications provided during treatment) shall be determined by review of the Medicare allowable amount for the billing hospital or physician in light of clinical considerations pertinent to the patient being treated.
(g) Medical care provided under direct contract. The Permitted Sharing Amounts for medical care provided by directly contracted hospitals or physicians will be the rates or fees established under the applicable contract; provided, however, that the amounts of such rates and fees shall be presumed to be usual, customary and reasonable only to the extent that they do not include otherwise improper balances, which charges shall be outside of the Permitted Sharing Amounts.
In the event that the Permitted Sharing Amount exceeds the actual charge billed for the treatment, service or supply in question, the program will share based on the actual billed charge. The Permitted Sharing Amount for medical care will not include charges related to unbundling, errors, unclear description or misidentification.
Balance Billing
An assignment of shared funds under the program is only permitted if accepted as consideration in full for services and treatment rendered. Upon acceptance of the membership card, the provider accepts the assignment of shared funds under the program, bills the program directly for payment, and then accepts payment directed to the provider on the member’s behalf.
By choosing that option rather than billing the member directly under an admissions contract, the provider agrees to be bound by all rules and provisions of the program. Per the Remittance Advice sent to the provider on the member’s behalf, together with the payment the provider accepts, the provider waives the right to balance bill and recover payment from the member for those services in an amount in excess of any required AUA, IUA, co-share, or ineligible amount (due to Guidelines restrictions); on accurate and valid charges.
Is this insurance?
No. Samaritan Given is a health care sharing program of Samaritan Ministries International (SMI) and is not insurance. Samaritan Ministries members are responsible for paying their own medical bills. Members participating in Samaritan Given ask for voluntary help from one another, receive shared funds from other members, and then pay their bills electronically through the program. SMI is a 501(c)(3) religious charity that administers a health care sharing ministry that enables Christians to help one another with medical needs without using health insurance. See 26 U.S.C. 5000A (d)(2)(B)(ii). SMI has been in operation since 1994, and its membership has more than 270,000 individuals worldwide—sharing $340 million in medical needs in 2019 alone—who depend on God to minister to all aspects of their health care needs.
All bills must be submitted to any applicable insurance or responsible third party prior to being submitted to Samaritan Given. Neither Samaritan Given nor Samaritan Ministries are legally responsible or liable for any medical bill that the member may have.
Because the ministry is not an insurance company, some of the terminology and processes are different than what you may be used to. SMI members do not pay "premiums," and money is not collected by SMI to "cover" members’ medical expenses. Instead, members send their monthly sharing portions directly to other members with medical needs. Sharing notifications are sent out weekly, and they inform the members who they’ll be sharing with, and the recipient’s prayer request. Once members receive their sharing notification, they send their designated amount, as well as a note of encouragement directly to the member with the medical bill.
NOTE: Since Samaritan Ministries is not insurance, none of the terms and language on this site should be interpreted as insurance terms. They should not be taken to imply, directly or indirectly, any guarantee of payment or transfer of risk.
More details about the program are available in the Guidelines for Samaritan Given.
Samaritan™ Classic and Samaritan™ Basic
If the patient does not have a membership card, or presents a membership card that resembles the following, use the information and instructions for Samaritan Classic and Samaritan Basic as described below:
General Program Information
Network
Samaritan Classic and Samaritan Basic do not have a network. You do not need to register with us in order to treat a patient.
No preauthorization, prior notification, or precertification to the provider is required.
Payment at Time of Service
The member is not required to make any payment at the time of service.
Billing
Please bill the member directly.
Do not send bills to Samaritan Ministries as such bills will not be processed. Members participating in Samaritan Classic and Samaritan Basic must submit their own bills to be considered for sharing.
Samaritan Ministries members are responsible for paying their own medical bills. As cash-pay patients, it is essential that members receive fair and reasonable prices for medical services rendered. It is customary for members participating in Samaritan Classic and Samaritan Basic to ask their providers for discounts in the competitive free-enterprise market for cash-pay patients.
For a member to have eligible medical bills shared with other members, they are required to submit itemized statements for services rendered that include:
- Provider Information (name, address, and phone number)
- Patient’s Name
- Date(s) of Service (when the service was actually rendered)
- Description of the services provided
- Charges for the services provided (both the initial price and price after discounts)
- Account number, if available
We require this itemization from our members to check for accuracy of services and to ensure the services provided align with the sharing guidelines of the member’s sharing program.
Once eligible member-submitted itemized bills are received in our office, the patient will generally begin receiving shares from other members within 60 to 90 days. Patients then use these funds to pay their provider’s office.
Initial Unshareable Amount (IUA) and Co-Share
Members participating in Samaritan Classic or Samaritan Basic do not have premiums or coinsurance. However, there are thresholds the member must meet prior to receiving shared funds from other members. These amounts apply per person, per medical condition or injury.
Initial Unshareable Amount (IUA): For each eligible condition/medical issue for which the member is submitting bills to be shared with other members, there is an initial amount that is not shared.
- Members in Samaritan Classic have a $400 IUA not offset by discounts.
- Members in Samaritan Basic have $1,500 IUA which may be offset by documented discounts received on eligible bills.
Co-Share: the percentage of eligible charges that are not shared once the IUA for a specific medical issue has been met (until the max co-share is reached).
- Members participating in Samaritan Classic have no co-share.
- Members participating in Samaritan Basic have a 10% co-share, max co-share of $13,500.
Payment
Samaritan members participating in Samaritan Classic or Samaritan Basic pay their providers directly. The member may receive money for eligible bills directly from other members.
Where does the money come from? Members send money directly to one another, either by online funds transfer or by check, in order to help pay for eligible medical bills.
How does my office receive payment? Members pay their own medical bills directly to the provider. Members may ask to be on a payment plan and make payments until they have received shares to pay the bill in full.
Learn more about Samaritan Classic and Samaritan Basic in the Guidelines for Samaritan Classic and Samaritan Basic.
Fair and Reasonable Pricing
Samaritan Classic and Samaritan Basic do not have fee schedules or allowed amounts, but in accordance with the Guidelines for Samaritan Classic and Samaritan Basic (see Section X.F.),
"Samaritan reserves the right, on behalf of its members, to determine what charges or parts of a charge are unfair or unreasonable based on techniques, criteria, and standards adopted by Samaritan Ministries. Samaritan will limit the sharing of charges determined to be unfair or unreasonable and will advocate on behalf of sharing members against any health care provider demanding payment of unfair charges. This guideline empowers Samaritan members to refuse to pay excessive charges, while also committing Samaritan to contend for fair prices on members’ behalf. Samaritan Ministries and third-party services will work with members and their providers to reach a resolution on excessive charges through negotiation and, if necessary, protect members through legal action. Samaritan will not leave an open bill dispute unresolved."
Balance Billing
Samaritan Ministries members are committed to paying a fair and reasonable price for the services rendered. If the provider attempts to bill the member unfair or unreasonable charges, the member may engage Samaritan Ministries and/or third-party services to work with the provider to reach a resolution. In these situations, the member will submit a fair and reasonable payment, according to the resolution agreed upon by the provider and/or an Explanation of Payment.
The third-party service, Samaritan Ministries, and/or the member will assist the provider with details regarding how the recommended payment amount was reached, and why it should be considered payment in full on accurate and valid charges.
Is this insurance?
No. Samaritan Ministries International (SMI), its sharing programs, and/or membership levels are not insurance. Samaritan Ministries members are responsible for paying their own medical bills. Members participating in Samaritan Classic and Samaritan Basic ask for voluntary help from one another, receive shared funds from other members, and then pay their own bills directly. SMI is a 501(c)(3) religious charity that administers a health care sharing ministry that enables Christians to help one another with medical needs without using health insurance. See 26 U.S.C. 5000A (d)(2)(B)(ii). SMI has been in operation since 1994, and its membership has more than 270,000 individuals worldwide—sharing $340 million in medical needs in 2019 alone—who depend on God to minister to all aspects of their health care needs.
All bills must be submitted to any applicable insurance or responsible third party prior to being submitted to Samaritan Ministries by the member for sharing. Samaritan Ministries is not legally responsible or liable for any medical bill that the member may have.
Because the ministry is not an insurance company, some of the terminology and processes are different than what you may be familiar with. SMI members do not pay "premiums," and money is not collected by SMI to "cover" members’ medical expenses. Instead, members send monthly shares directly to other members with medical needs. Share notifications are sent out monthly by Samaritan Ministries which inform the members who they’ll be sharing with and the recipient’s prayer request. Once members receive their share notification, they are encouraged to send their designated amount and a note of encouragement directly to the member with the medical bill.
NOTE: Since Samaritan Ministries is not insurance, none of the terms and language on this site should be interpreted as insurance terms. They should not be taken to imply, directly or indirectly, any guarantee of payment or transfer of risk.
More details about the program are available in the Guidelines for Samaritan Classic and Samaritan Basic.