| Update on Chief Medical Officer Search |
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Charles Zonfa, M.D., MBA, FACOG, has been named senior vice president, chief quality officer, effective May 9, 2022. This new senior leadership position was created to provide quality transparency and consistency across the organization with one leader accountable for improving quality.
Interviews continue in the search for Dr. Zonfa’s replacement as Chief Medical Officer. As more information becomes available, it will be shared with SummaCare provider partners.
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| Individual & Family Plans |
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SummaCare’s Individual & Family plans have more than doubled in membership! Please take a moment to review the plan benefits here and understand they use the SCConnect network. This network provides access to many of the area’s finest physicians, facilities and hospitals including Summa Health, Cleveland Clinic Mercy Hospital and Akron Children’s Hospital.
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The Health Outcomes Survey (HOS) is administered in August to a sample of Medicare members for a baseline measurement and for those who previously took the survey, a follow-up survey. Both surveys contribute to SummaCare's Star Ratings. Continue talking with your Medicare patients about physical and mental health, fall prevention, and urinary incontinence.
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| Provider Satisfaction Survey |
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SummaCare is committed to improving provider satisfaction. A total of 1,500 surveys were mailed to provider offices on July 1. If your office received the survey, please complete it and you will receive a $5 Starbucks gift card. Your valuable feedback will assist SummaCare in identifying plan strengths and opportunities for improvement.
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| Care & Condition Management |
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When members require education on how to better manage their chronic conditions or serious illnesses, SummaCare is there with support to help improve their overall quality of life. A registered nurse can provide education on the risks of conditions, explain medications, teach self-management tools, encourage recommended screenings and coordinate additional services as needed. Members may also be eligible for Healthy Home Monitoring with Medtronic.
Providers may refer a member by calling SummaCare’s Health Service Management line at 877.888.1164 or by sending an email to casemanagement@summacare.com. Members may also call the Customer Service number listed on the back of their insurance card. Our programs are voluntary and a member can opt out at any time.
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SummaCare bases utilization management (UM) decision-making only on appropriateness of care, service and existence of coverage. Decisions are based on reasonable medical evidence and consensus of relevant healthcare professionals. Clinical decisions about each request for service are based on the clinical features of the individual case and the medical necessity criteria.
SummaCare receives routine and expedited/urgent requests to authorize services from 8:30 a.m. to 5:00 p.m. at 330.996.8710 or 888.996.8710 (TTY 800.750.0750). SummaCare maintains an incoming fax line available 24 hours a day, 365 days a year dedicated to receiving incoming authorization requests. Routine requests to authorize services can be faxed to 234.542.0815 using the Prior Authorization Request Form for Services. For urgent/expedited requests call 330.996.8710 or 888.996.8710 (TTY 800.750.0750).
For additional resources and information, click here.
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SummaCare is committed to improving cultural health competency network-wide. We encourage our providers to receive training on equity, cultural competency, bias, diversity and inclusion including the U.S. Department of Health and Human Services, Office of Minority Health free, continuing education e-learning (Culturally and Linguistically Appropriate Services in Maternal Health Care, Behavioral Health, Oral Health) programs designed to help health care professionals provide culturally competent care. For more information about provider training on equity, cultural competency, bias, diversity and inclusion, please contact your Provider Engagement Specialist at providerengagement@summacare.com.
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Following the Federal No Surprises Act, SummaCare is requesting that each location attest their information every 90 days through BetterDoctor. Failure to attest the correctness of your demographics, could lead to your information being suppressed from provider directories like the ones found on summacare.com among others.
Learn more here.
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| Member Rights & Responsibilities |
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SummaCare member rights and responsibilities statements help ensure that members are treated by SummaCare employees and all of our contracted providers with fairness and respect. Please read them carefully. Likewise, it is important that individuals understand their responsibilities as a SummaCare member. If members do not follow these responsibilities, they may not receive all of the services or coverage to which they might otherwise be entitled.
View Member Rights & Responsibilities.
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| CMS Medicare Provider Compliance Newsletter |
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View the latest CMS Provider Compliance Newsletter to learn about avoiding common billing errors and other erroneous activities when dealing with the Medicare Fee-for-Service (FFS) Program. This newsletter includes guidance to help health care professionals address and avoid current top mistakes.
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| Summa Health's Vitality Magazine |
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Six questions to ask before choosing a Medicare Advantage plan
Whether you’re just turning 65 and newly eligible for Medicare or you’re simply looking to enhance your current Medicare coverage, there are key things to consider when weighing your options for a Medicare Advantage plan.
Read more.
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