How to Become a Network Health Services Provider at SummaCare

How to Become a Network Provider

Thank you for your interest in becoming a contracted provider! Please complete and submit the appropriate provider Form and a member of the Contracting Department will contact you to discuss your eligibility for our network.

As a SummaCare provider, you can rely on:

An Ohio based company with its corporate headquarters located in Akron, Ohio. We care because we live here, too.
A dedicated local provider support team to keep you informed and maintain support in person, by email or by phone.
Initial and ongoing provider education through orientations, office visits, training and updates.
The ability to check member eligibility, authorization and claims status 24/7 through our secure online portal.
A dedicated local claims team to ensure prompt payment.
A comprehensive approach to care for your patients through disease management programs, healthy behavior incentives, and quality care for the people in populations we serve.

To become a network provider, select your provider type below and follow the simple steps.

Physician/Practitioner

Thank you for your interest in becoming a SummaCare Network Physician/Practitioner. Please review the following information and then continue with your application.

Are you located in or provide services within our service area?

Are you one of these licensed provider types?
Currently SummaCare credentials the following provider types: MD, DO, DC, COM, PhD, PA, CNM, CNS, EdD, PsyD, LISW, LPCC, PCC, BCBA/COBA, LIMFT, LICDC, RD, DMD (oral & maxillofacial surgery only).

Are you board certified or board eligible?
SummaCare requires board certification for MD, DO, DPM and DDS by one of the following: The American Board of Medical Specialties, American Osteopathic Association, American Board of Foot and Ankle Surgery, American Board of Podiatric Medicine, American Board of Oral & Maxillofacial Surgery, or The American Society of Addiction Medicine.

Are you able to comply with the following expectations:

24/7 availability or direction on where members are to go/call for help
Cross-coverage by a SummaCare Network Provider when unavailable
Admitting privileges at a SummaCare in-network hospital, or have a signed Hospital Coverage Agreement stating who will be admitting and caring for SummaCare members on their behalf.

If you answered YES to the items above:

Complete and return a Provider Services Request for Network Participation Form.

Please note: All new provider requests, including new providers being added to an existing contracted Tax ID need to complete the form. Incomplete forms will not be accepted.

Once your form is received:

Contracting

Your form will be reviewed for service area, specialty, provider type, services provided and network need.
If approved, a contract will be sent to the representative listed on the form.
If denied, the representative listed on the form will be notified of the denial.
Please note: Once you return the signed contract back to us stating that the contract terms are agreed upon, we will begin the credentialing process. You cannot see members until you successfully complete the credentialing process.

Credentialing for Physicians / Practitioners

Physicians and practitioners must have a CAQH (Council for Affordable Quality Healthcare) application completed in order to be credentialed.
Credentialing can take up to 90 days from the date SummaCare receives all requested documentation.
Upon approval of credentialing, your contract will be assigned an effective date and returned to the representative listed on the form. Denials will be notified within 30 days of this decision.
Questions regarding your credentialing status should be directed to the credentialing team directly by calling 330.996.8554 or by email to SCcredentialing@SummaHealth.org.

Ancillary Services Facility or Provider

Thank you for your interest in becoming a SummaCare Network Ancillary Services Facility or Provider. Please review the following information.

If you are providing services within our service area such as skilled nursing facility, surgery center, clinic, health department, physical therapy center, in-patient hospital or behavioral health center, please complete the Ancillary Services Request for Network Participation Form and return it to us. Please feel free to include any other information that will help us make an informed decision regarding your services.
If you are providing services on a national level such as labs, cardiac event monitoring, or telehealth, please complete the Ancillary Services Request for Network Participation Form and return it to us. Feel free to include any other information that will help us make an informed decision regarding your services.

Please note: Incomplete forms will not be accepted.

Once your form is received:

Contracting

Your form will be reviewed for service area, specialty, provider type, services provided and network need.
If approved, a contract will be sent to the representative listed on the form.
If denied, the representative listed on the form will be notified of the denial.
Please note: Once you return the signed contract back to us stating that the contract terms are agreed upon, we will begin the credentialing process. You cannot see members until you successfully complete the credentialing process.

Credentialing for Ancillaries & Facilities

Credentialing can take up to 90 days from the date SummaCare receives all requested documentation.
Upon approval of credentialing, your contract will be assigned an effective date and returned to the representative listed on the form. Denials will be notified within 30 days of this decision.
Questions regarding your credentialing status should be directed to the credentialing team directly by calling 330.996.8554 or by email to SCcredentialing@SummaHealth.org.

DME Provider

Thank you for your interest in becoming a SummaCare Network DME Provider. Homelink is SummaCare's DME Network Manager. All providers are required to join the Homelink provider network in order to provide DME services to SummaCare members. .

Requests to join the SummaCare DME Network should be sent to Homelink. Please contact Shawn Joblinske, Director of Payer Relations at Homelink:

Call: 855.719.6624
Email: Shawn.Joblinske@VGM.com

Upload Your Form

Once you've completed the Provider Services Request for Network Participation or the Ancillary Services Request for Network Participation Form, please fill out the fields below, click "Choose File" to attach your completed form and then click the "Submit" button.

Questions? We are here to help.

If you have submitted an application to SummaCare and have not heard back after 60 days, please contact the Contracting Department by calling 330.996.8738, or by email to SCContracting@summacare.com.

Provider Support Services

By Phone:

330.996.8400

800.996.8401

By Email:

providerengagement@summacare.com

Provider Engagement Specialists

If you have not met with your assigned Provider Engagement Specialist or would like to schedule an in-office training or meeting to address any questions regarding the authorization process, claims issues, appeals, SummaCare products/benefits or Plan Central training, please contact the assigned Provider Engagement Specialist for your office.

Find Your Specialist

Plan Central

View patient eligibility, benefits, claims status, and self-funded prior authorization lists, as well as review clinical edits and clarifications.

Request Access