Resources & Self Service

At SummaCare, we want to make it easy for you to provide quality care to our members! In this section you’ll find online tools, downloadable forms and information to help you do business with us.

Forms

• Become a Network Provider
• Claim Adjustment Requests
• Coordination of Care Form 
• EDI Registration 
• NPI Submission Form
• Prior Authorization Form
• Provider Information Change Form 
• Step Therapy Request Fax Form
• Medication Request Form

Resources

• Clinical Practice Guidelines -SummaCare’s clinical guidelines include recommendations, strategies and other information to assist healthcare professionals in making decisions about appropriate healthcare for specific conditions.
• Prior Authorization  -SummaCare utilizes one prior authorization list for all fully-insured PPO/POS/HMO and Medicare (Secure) plans. To view prior authorization lists for self-funded groups, please visit Plan Central and click on "Provider Documents" after logging in.
• Prior Authorization List for Drugs - Find out what prescription drugs under the medical benefit require prior authorization
• Member Rights and Responsibilities
• Pharmacy Management - SummaCare's Prescription Drug Benefit incorporates utilization management programs that appy restrictions on certain drugs.
• Provider Search -Search SummaCare’s provider network.
• Provider Manual

Self Service Tools

Plan Central
Log in to Plan Central to view patient eligibility, benefits, claims status and self-funded prior authorization lists.

New user? Request access to Plan Central.

Claim Check
Log in to Clear Claim Connection to review clinical edits and clarification.

New user? Request access to Clear Claim Connection.

Contact Us
If you have questions, email contactproviderservices@summacare.com.