Provider FAQs

No, but certain procedures, hospital admissions, and specialty services do require authorization. You may review the prior authorization list and details regarding submission under Prior Authorization for Providers.

Claim status can be checked through Plan Central at www.summacare.com/plancentral.

If you do not have access, follow the registration instructions on the login page or contact Provider Support Services for assistance.

Providers can update their information by filling out the provider change form- form-provider-information-change.pdf and submitting it to sccontracting@summacare.com. 

Eligibility and benefits can be checked through our provider portal- Plan Central at www.summacare.com/plancentral.

You can apply to join our network by submitting an online provider application at www.summacare.com. Click on the Providers link and then Become a Network Provider.

Claims can be submitted electronically through your clearinghouse using payer ID 95202 for fully-funded plans and 34916 for self-funded plans. If you have questions about setting up your electronic data interchange (EDI) with SummaCare, please contact edisupport@summacare.com

Providers must undergo re-credentialing every 3 years to maintain network participation.

You can access your Explanation of Payment (EOP) statements through the Plan Central provider portal. Once logged in, click on inquiries and then EOP. You can retrieve the EOP by simply entering the check number, check from date and to date or the member’s first and last name only.

The SummaCare networks include: SC Medicare, SC Premier, New Health Connect Summa, New Health Connect Summa Home Health, New Health Connect Pioneer, Mercy Choice, Preferred Choice, SC Select, and SC Connect.

To confirm the networks your office/facility participates in, navigate to the Provider section and select Find a Network Provider. Scroll to the middle of the page and click non-member provider search (provider network search). Under networks, be sure “all networks” is selected and enter the provider’s name or facility. Click search and once your listing appears, click on the name or facility to view the full profile. Scroll down to the Networks Accepted section to see the SummaCare networks in which you are listed as a participating provider. 

To submit a claim dispute, please log in to Plan Central. If you do not have a user account, please register by clicking the registration link located on the Plan Central homepage. After logging in, please locate your claim using the "Claim Inquiry" menu. When your search results appear, click on the claim to view the details. When you click the button titled "Adjustment Request," a window will appear with various options to help us understand why the claim should be adjusted. Providers must submit claim disputes within 60 days of the claim determination, including supporting documentation. 

Claims must be submitted within 365 days from the date of service.

The latest version of our Provider Manual is available on our website under the Provider link and then click Provider Manual.