SummaCare’s clinical practice and preventive health guidelines include recommendations, strategies and other information to assist physicians, healthcare practitioners and patients in making decisions about appropriate healthcare for specific conditions. The clinical practice guidelines come from evidence-based national sources. Recommendations in the guidelines are not a substitute for a physician or other healthcare provider’s clinical judgment and may not be applicable to each individual. Treatment decisions should be decided between physicians or other healthcare providers and the patient, do not guarantee outcome and are not to interfere with clinical decisions made by treating providers.
Links to other websites do not constitute or imply endorsement by SummaCare.
These Clinical Practice Guidelines in no way constitutes benefit coverage. Refer to individual plan document for benefit coverage.
Antibiotic Treatment - Pediatric
Chronic Kidney Disease Guidelines
Pain Management Program Guidelines
Peripheral Artery Disease Executive Summary
Peripheral Artery Disease Guidelines
Progesterone Therapy Guidelines
Preventive care services can help detect illness or injury early – a key to successful treatment of any condition. SummaCare’s preventive health guidelines for age-appropriate screenings.
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.