Medicare Non Par Provider Appeals

If you are a non-contracting provider who has provided services to a SummaCare member, and you have received a denial notice you have the right to appeal our decision
If you believe we should have covered the service, file your appeal in writing within 60 calendar days after the date of this notice. The time can be extended if you can provide evidence for what prevented you from meeting the deadline.

Waiver of Liability 
In order to consider a request for an Appeal, you must complete a Waiver of Liability Statement; holding the enrollee harmless regardless of the outcome of the appeal.Once we receive the completed Waiver of Liability form, we will give you a decision on your appeal within 60 calendar days. 

Documentation
All appropriate documentation should be included in the request for reconsideration; such as a copy of the original claim, remittance notification showing the denial, and any clinical records and other documentation that supports your request for reimbursement. 

How do I ask for an appeal with SummaCare Medicare Advantage?
Mail or deliver your written appeal to the address below: 
Mail:
ATTN: Appeals & Grievances
SummaCare
P.O. Box 1107
Akron, OH 44309-1107


Deliver:
ATTN: Appeals & Grievances
SummaCare
10 North Main Street
Akron, OH 44308


Phone: 330-996-8885
Toll Free: 800-996-6250
TTY: 800-750-0750      

What Happens Next?
If you appeal, we will review our initial decision. If payment for any of portion of your claim(s) is still denied, we will forward your appeal to the Centers for Medicare & Medicaid Services Independent Review Entity (IRE) for a new and impartial review. If the IRE upholds our decision, you will be provided with further appeal rights as appropriate.