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Provider News

SummaCare’s "Provider News" is meant for physicians and office staff and features health insurance news, health and wellness information, clinical and quality management information, helpful tips for providing care to SummaCare members and important reminders from our Provider Support Services team. If you’d like to receive the Provider          e-newsletter, please register for Plan Central using the Provider Registration link.

View archived newsletters and memos below:

2025 

September

Outpatient Prior Authorization Requirements 

August

Modifier 25 Payment Policy
GuidingCare Go-Live Delay
Pharmacy Site of Care Policy and Drug List

July

Provider Q3 Newsletter
GuidingCare Registration and Training Videos

June
GuidingCare New Prior Authorization Portal 

May
Provider Changes/Reminder Notification
New Prior Authorization Requirements

April
Provider Q2 Newsletter
Prior Authorization for Out of Network Labs

March
Ambulatory Surgical Center Certification Requirement

February
Medical Pharmacy Partnership with Prime Therapeutics

January
Provider Q1 Newsletter

 

 

2024

December
Claim Edit Details
Transition of Care Code Pilot
Provider Formulary Change

November
SummaCare Medicare Out of Network Referrals

NDC Guidance

October
CPT Code 96127
SummaCare vs EviCore Prior Authorization
Medicare Prescription Payment Plan
Behavioral Health Quality of Care


September
Critical Access Hospital Billing
Non-Emergency Ambulance Services

August

Annual Provider Update Webinar

July

Provider Q3 Newsletter

June
Ortho Provider Update

May
Non-Emergency Transport
Change HealthCare Reconnection
Hospital-Based Clinic Services

April
Hospital-Based Clinic Services
Ambulatory Surgery Center Memo
New Specialty Drug Editing Software
Provider Q2 Newsletter

March
An Update on Prior Authorization
Change Healthcare Updates
Medicare Unlikely Edits Memo
KX Modifier Letter

February
Change HealthCare Disruption

January
Provider Q1 Newsletter
Inpatient Only Procedures Letter

2023

December 
Formulary Change Letter

August
Provider Q3 Newsletter

May
Provider Q2 Newsletter

January
Provider Q1 Newsletter
Provider Memo: Network Letter
Provider Memo: Colorectal Screening Measure Update
Provider Memo: Kidney Health Evaluation for Diabetic Patients

2022

December
Provider Memo: Fee Schedule Change

October
Provider Memo: Q4 Updates

August
Provider Memo: Q3 Updates

April
Provider Memo: SUPD
Provider Memo: SUPD Expanded List
Provider News 04.19.22: Q2 Updates
Provider Memo: BrainHQ 

February
Provider Memo: Change to Back Program Prior Authorization
Provider News 02.14.22: Q1 Updates

2021

December
Provider Memo: Summa Health System’s Employee Assistance Program
Provider Memo: Check Your Networks

October

Provider News 10.13.2021: Q4 Updates

August
Provider Memo: Behavioral Health and Utilization Management
Provider Memo: Concurrent Review for Acute Rehab and LTACs

July 
Provider News 07.06.2021: Q3 Updates

May
Provider Memo: Evicore Auth Requests
Provider Memo: Radiology Reads

April
Provider News 04.22.2021: Q2 Updates

March
Provider Memo: Incomplete Prior Auth Form

February
Provider News 02.11.2021: Register Now: SummaCare's Vendor Spotlight

January
Provider Memo: Procedure and Surgery Prior Authorizations
Provider News 01.26.2021: Q1 Updates

Vital Coverage Blog

Read Vital Coverage, SummaCare’s bi-weekly blog dedicated to bringing the latest health insurance news, benefits and updates as well as health and wellness tips.

Questions? We are here to help.

Provider Support Services

By Phone:

330.996.8400

or

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.

Plan Central

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

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