Claim Editing Software

SummaCare uses a claim editing software called CES, and it is available to providers though Plan Central. Do you have a Plan Central account? If so, you can access CES on the Plan Central homepage. Not a Plan Central user?Register for an account.

Important billing guidelines:

  • When submitting claims for Medicare Advantage members, please bill SummaCare as you would bill Traditional Medicare, including all Medicare reimbursable codes with applicable modifiers.
  • When submitting claims for Commercial members, please continue to bill in accordance with industry standard guidelines.

As a reminder, SummaCare does not have an appeal process for inquiries associated with code edits performed during the claim adjudication process. We are confident in the clinical rationale used to implement these code edits. The CES Provider Portal will help you obtain explanations for claim edits at your convenience.