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:
Thank you for your interest in becoming a SummaCare Network Physician/Practitioner. Please review the following information and then continue with your application.
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.
Contracting
Credentialing for Physicians / Practitioners
Thank you for your interest in becoming a SummaCare Network Ancillary Services Facility or Provider. Please review the following information.
Please note: Incomplete forms will not be accepted.
Contracting
Credentialing for Ancillaries & Facilities
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:
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.
No. While many routine services do not require approval, certain procedures, inpatient admissions, and specialty services do require prior authorization. Providers can review the full authorization requirements and submission instructions in the Prior Authorization for Providers section.
Claim status is available through the Plan Central provider portal at summacare.com/plancentral.
Providers without access can follow the registration steps on the login page or contact Provider Support Services for help.
Practice updates such as address changes, phone numbers, or tax ID updates can be submitted by completing the Provider Information Change Form and emailing it to sccontracting@summacare.com.
Eligibility and benefit details can be confirmed through the Plan Central provider portal at summacare.com/plancentral.
Providers interested in joining the SummaCare network must complete the online provider application available at summacare.com. Select the Providers section and choose “Become a Network Provider.”
Claims should be submitted electronically through your clearinghouse using the appropriate payer ID:
Participating providers must complete re-credentialing every three years to remain in the network.
EOP statements are accessible through the Plan Central portal. After logging in, select “Inquiries” and then “EOP.” Providers can retrieve EOPs by entering the check number, date range, or the member’s first and last name.
SummaCare networks include:
To verify network participation, visit the Providers section and select “Find a Network Provider.” Choose the non-member provider search, ensure “all networks” is selected, and search by provider or facility name. Once results appear, open the profile and review the “Networks Accepted” section.
Claim disputes must be submitted through Plan Central. After logging in, locate the claim using the Claim Inquiry menu, open the claim, and select “Adjustment Request.” Providers must submit disputes within 60 days of the original claim determination and include all supporting documentation.
Claims must be filed within 365 days from the date of service.
The most current Provider Manual is available on the SummaCare website under the Providers section by selecting “Provider Manual.”
By Phone:
By Email:
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.
View patient eligibility, benefits, claims status, and self-funded prior authorization lists, as well as review clinical edits and clarifications.