| SummaCare Medicare Advantage Plans Achieve 5 STARS |
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We are honored and incredibly proud to have received 5 STARS - Medicare’s highest rating for SummaCare Medicare Advantage plans for 2023. We have been providing high-quality, cost-effective coverage to our Medicare members for over 25 years. This highest-star rating from CMS underscores the commitment and tremendous dedication that our entire SummaCare team and our incredible network of healthcare providers all have to improving the health, well-being and experience for our members.
We want to take a moment to thank our Physicians and Providers for the care you deliver to our SummaCare members. Your attention to closing care gaps by scheduling preventive health visits and managing chronic conditions supports our effort to deliver high quality care. Following up with test results, ensuring medication adherence and care coordination are just a few of the areas you support the overall health of our members.
This rating demonstrates our commitment to being the trusted and preferred navigator to high-quality healthcare that improves the quality of life for our members and the communities we serve.
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| SummaCare Medicare 2023 Highlights |
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New Jade (HMO) Plan Bene-Flex™
- Allows members to choose five customized extra benefits (from more than 15 options) in addition to core plan offerings for a $19 monthly premium. Should a Jade plan member’s health needs change, members may elect different extra benefits each year.
Additional Enhancements for Most 2023 SummaCare Medicare Advantage Plans
- Lower urgent care copays
- No pharmacy deductibles on any plan
- Lower out-of-pocket maximums
- Dental coverage increased up to a $2,000 maximum through the Delta Dental network
- Dental coverage expanded to include bridges, crowns and dentures
- Expanded travel benefits
Additional Enhancements for All 2023 SummaCare Medicare Advantage Plans
- New SummaCare Visa card for utilizing Over-the-Counter (OTC) benefits online, by mail, by phone or at more than 62,000 retail locations nationwide
Expanded Medicare Service Area
- Grows to 33 counties in 2023 with the addition of Erie and Sandusky counties.
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How will patients find you?
- Have you attested to Better Doctor for SummaCare’s Directory Accuracy?
- Do you know that SummaCare is required to remove providers from the directory if the providers have not attested?
- Did you know you need to attest every 90 days?
- Do you know what Better Doctor is?
- Are you aware of the No Surprises Act and what is required by providers for their data to be accurate?
If you answered “no” to any of these questions, do not hesitate to reach out with any questions for SummaCare or how to contact Better Doctor.
Contact SummaCare Provider Support Services at 330.996.8400, 800.996.8401 or contactproviderservices@summacare.com.
Contact Quest Better Doctor at 844.668.2543 M–F, 9 a.m.–5 p.m. CT or support@betterdoctor.com.
Email quarterly Provider Group roster to rosters@questanalytics.com.
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| Claim Adjustment Request & Appeals |
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Visit our Provider Resources webpage for more information on dispute and claim adjustment requests as well as pre-service and post-service appeals. Here you will find documents detailing the processes.
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Even though you are a SummaCare contracted provider, your practice may not participate in every network. Please check your contract to confirm network participation and confirm each physician’s participation by using our online provider directory. If you need help searching the directory, watch the Provider Search tutorial video here.
When seeing patients, please login to Plan Central to verify eligibility and benefits.
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Flu season is upon us and SummaCare is notifying our members of the importance of getting a flu vaccine. Fully-insured members do not have to meet any demographic or clinical criteria to receive a vaccine. In addition, they are able to get their vaccine, with no copay, at a number of locations, including your office(s).
If your office administers flu vaccines to our members, you will be reimbursed the lesser of billed charges or the following rates, less any member financial responsibility (e.g. self-insured, if applicable). Click here to view the 2022 Flu Vaccine rate sheet.
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Why encourage patients to workout? The benefits may surprise you! Besides getting stronger, exercising may help sharpen the mind, prevent/manage chronic conditions and reduce risk for falls. Find the classes that are right for your patients with SilverSneakers, their SummaCare fitness benefit. Start here.
Did you know Medicare members are surveyed on whether or not their provider talks to them about their level of physical activity and makes recommendations to start, maintain or increase their physical activity? This survey contributes to our Star Ratings.
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If you’re searching for insurance options for your team, we encourage you to explore the SummaCare affordable small group options available in your area. Visit summacare.com/employer-sales or call 330.996.8955 or 800.375.6530 to find an ideal plan for your team.
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| Summa Health’s Vitality eNewsletter |
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Build-Your-Own Medicare Advantage Plan with SummaCare’s New Jade (HMO) with Bene-Flex
SummaCare is committed to contributing to a healthy community by guiding members to be the healthiest versions of themselves. That’s why we take pride in going beyond basic Medicare with valuable extra benefits designed to fit your different needs to reach optimal health.
Read more.
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