To request a claim adjustment, 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 so we can understand why you feel your claim should be adjusted.
If you have any questions, please contact Provider Support Services at contactproviderservices@summmacare.com or call 330.996.8400 or 800.996.8401.
SummaCare's claim editing software is available to providers through Plan Central. If you do not have a user account, please register by clicking the registration link located on the Plan Central homepage.
Important billing guidelines:
As a reminder, SummaCare does not have a dispute process for inquiries associated with code edits performed during the claim adjudication process. We are confident in the clinical rationale used to implement these code edits. The Provider Portal will help you obtain explanations for claim edits at your convenience.
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.