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1st Quarter 2022

2022 CAHPS

The Consumer Assessment of Healthcare Providers & Systems (CAHPS) survey will begin in April 2022 to assess members’ experience with the health plan and their health care providers, recalling on experiences that occurred during the past six months. Member experience will account for 60% of the 2023 Star Rating (measurement year 2022).

The following questions and responses/scores are related to your patients’ experience with their health care:

1. Annual Flu Vaccine (score: 80%)
2. Overall Rating of Health Care Quality (score: 90%)
   • Rate all your health care in the last 6 months
3. Getting Care Needed (score: 87%)
   • Easy to get needed care, tests or treatment
   • Get a specialist appointment as soon as needed
4. Getting Appointments and Care Quickly (score: 84%)
   • Get as soon as needed, when it’s needed right away
   • Get routine care as soon as needed
   • Seen within 15 minutes of your appointment time
5. Care Coordination (score: 88%)
   • Personal doctor had medical records or other information about previous care
   • Doctor's office followed up to give test results
   • Get test results as soon as needed
   • Personal doctor talked about all the prescription medicines being taken
   • Personal doctor's office helped to manage care among different providers and services
   • Personal doctor seemed informed and up-to-date about the care from specialists
6. Getting Needed Prescription Drugs (score: 94%)
   • Easy to use prescription drug plan to get the medicines prescribed
   • Easy to use prescription drug plan to fill a prescription at a pharmacy
   • Easy to use prescription drug plan to fill a prescription by mail

Note: Scores are from SummaCare’s Medicare 2021 CAHPS survey.

Member Incentives

Medicare members who complete an Annual Wellness Visit during 2022 will receive a $50 Giant Eagle gift card.

Marketplace (Individual & Family plans, both on- and off-Marketplace) members who are 18 years and older, will receive a gift card for visiting their PCP during 2022 to encourage creating a relationship with their PCP.

• Dates of Service between 1/1/22 – 4/30/22 = $50 Giant Eagle gift card
• Dates of Service between 5/1/22 – 12/31/22 = $25 Giant Eagle gift card

Gift cards will be sent to members within 45 days after claims are paid by SummaCare.

Welcome to our newest Provider Engagement Specialist!

Jaime Reed

Jaime joins SummaCare with over 14 years of experience in the healthcare industry. She has held positions in both the hospital and provider office settings as an office manager, financial/office coordinator and clinical roles as a certified medical assistant and phlebotomist. Please welcome Jaime as she brings a wealth of knowledge to our team!

Assigned counties: Summit and Cuyahoga (see map), Erie, Huron, Lorain, Medina, Ottawa, Sandusky, Seneca

• Phone: 330.996.8698
• Email: reedja@summacare.com

Coming Soon!

SummaCare continues to focus on providing more information to you via Plan Central. In the coming weeks, you will be able to obtain detailed adjudication edit information at both the claim header and service line levels. We will also continue to support mock or “what if” claim scenario entry for professional claims. Please look for additional information in Plan Central soon.

New for 2022 Medicare Members

Effective 1/1/2022, Medicare Advantage members can receive Tier 1 zero dollar generic fills for 100 day supply. Filling of maintenance medications for a 100 day supply promotes adherence and is more convenient as members have to make trips to the pharmacy less often. We encourage you to discuss with your SummaCare patients and write for the 100 day supply with their next prescription. This can even be done on an initial prescription as long as it is for the Tier 1 generic medication. Please note that the standard 30, 60, and 90 day supplies will still be honored.

View more information on Formulary Changes.

Quest Analytics BetterDoctor

Did you know that federal and many state regulations require health plans — and often providers — to verify the accuracy of their provider directory information regularly, typically every 90 days? More importantly, an accurate provider directory ensures we can connect the right patients more easily to you.

That’s why we’re excited to announce our partnership with Quest Analytics to streamline your verification process through their BetterDoctor solution.

BetterDoctor is trusted by 700,000+ healthcare professionals from 360,000+ locations to attest their information through their online verification portal. It’s one way we’re making administration of your provider data easier and helping you keep your information updated, meet compliance and contractual requirements, enhance relationships with patients and plans, and maintain a successful, thriving business. Plus, BetterDoctor is specifically designed to help reduce your regulatory risks by keeping a record of every change made to your provider data: what was changed, by whom, and when.

In most cases, regulators audit plan directories by calling offices to verify the physicians practicing at that location. BetterDoctor also may contact physician practices by email, fax, telephone and U.S. mail to request a review and direct them to BetterDoctor’s online verification tool. You are encouraged to respond to these outreaches to ensure an accurate directory for all our members.

Some common discrepancies identified in provider directories include:

• The practitioner does not practice at the office.
• The practitioner is not accepting new patients.
• The phone number is incorrect or disconnected.

For more information about SummaCare and BetterDoctor, physicians can call our Provider Support Services at 330.996.8400 or 800.996.8401 or contactproviderservices@summacare.com.

For more information about BetterDoctor, visit their website questanalytics.com/solutions/betterdoctor/. You may also contact them at support@betterdoctor.com or by phone at 844.668.2543, Monday through Friday, 9 a.m. to 5 p.m. central time.

SummaCare Enhanced Support Program

As of January 24, 2022, SummaCare is offering a new home supportive care program to our members which is offered in collaboration with Carecentrix. It is a community-based palliative program provided by specially trained nurses and social workers from the palliative team at Summa Health. In collaboration with you, the member’s physician, these clinicians will provide home, video and phone visits to the member which will include comprehensive palliative assessments, assistance with social determinants of health concerns, support for the member and caregiver, and goals of care discussions with the member and their providers. This service is offered at no additional cost to the member and is included in health plan coverage to SummaCare members.

Providers will receive notification when a member of their practice is enrolled in the program. Direct referrals can be made by emailing referral information to referrals@turn-keyhealth.com. For questions regarding the program, please call 234.867.7015 from 8 a.m. to 5 p.m., Monday through Friday.

Ambulance Network

Cooperative Health Partners (CHP) is SummaCare’s exclusive provider and network manager for medical transportation. CHP is a member-owned statewide medical transportation network comprised of 15 of Ohio’s premier transportation companies.

• Basic life support
• Advanced life support
• Mobile intensive care units
• Specialty care transports
• Air transports

To arrange for medical transportation for SummaCare members, call 330.996.8791 or 866.996.8791.

Cleveland Clinic

SummaCare Medicare Advantage members now have access to approximately 6,000 Cleveland Clinic providers across all Northeast Ohio locations, including Cleveland Clinic Akron General.

SCPremier Commercial Network includes Cleveland Clinic Akron General and its related entities to its network.

The Preferred Choice Network is a new network comprised of Summa Health, Cleveland Clinic and Akron Children’s Hospital.

Visit SummaCare for more information.

Employee Assistance Programs (EAP)

The ongoing COVID-19 pandemic has put a strain on the physical and mental health of many. It can be an even greater challenge for patients who are working hard to maintain their careers and balance life in a “new normal” created by the pandemic.

Employee assistance programs are here to help. Advise your patients to talk with their employer to see if services are available to them and their family.

Learn more about the Summa Health/SummaCare EAP.

Medicare Plan Highlights

When seeing your SummaCare Medicare patients don’t forget they have several SummaCare Medicare Benefits for 2022:

• BrainHQ – provides the exercise your brain needs to be at its sharpest.
• PERS (Personal Emergency Response System) – included with the Emerald plan only.

View more 2022 additional plan benefits.

Check Your Networks

SummaCare would like to remind you of the importance of verifying member eligibility, benefits and network participation. Your practice may not participate in every network. Your patient’s network and/or benefits may change from year to year.

Visit this PDF for more information.

Information Regarding Rate Changes

Medicare rates changed on January 1, 2022. Commercial rates will change on April 1, 2022. Please reference your Exhibit A in your contract for reimbursement rates. Rate availability for Medicare rates is dependent on the finalization and publication of rates by CMS. This may result in adjustments to claims to apply the current rate for the date of service.

For information on the Medicare fee schedule (RBRVS), visit cgsmedicare.com.

Example of how to calculate reimbursement:
RBRVS x Multiplier = SUMMACARE Reimbursement
RBRVS for CPT Code 99213 = $57.96
Multiplier = 105%
$57.96 * 1.05 = $60.86

FAQs

Looking for provider policies, resources, news and education?

Check out our Provider page on our SummaCare website!

SummaCare's dedication to serving our members is receiving national recognition

SummaCare is proud to share that our 2022 Medicare Advantage Plan recently earned a 4.5 Star Rating (out of 5) from the Centers for Medicare and Medicaid Services (CMS).

Learn more.