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Plan Central

Plan Central is SummaCare’s secure web-based platform for performing functions including, but not limited to:

  • Eligibility and benefit inquiries
  • Claim status review
  • Submission of claim disputes
  • Review of payment details
  • Retrieving your explanation of payments
  • Checking an authorization status or via EviCore by Evernorth or GuidingCare™
     

Why Use Plan Central

  • Standardized submissions
  • Improved turnaround times
  • Provides online tracking 

Claim Disputes

Claim disputes will no longer be accepted via fax, mail or the Provider Support Services’ email inbox effective March 4, 2026. This change is part of our ongoing efforts to streamline inquiries, improve tracking and properly categorize issues for resolution.

Submit all claim disputes through the SummaCare Plan Central portal.

When submitting a dispute or adjustment request, please include all supporting documentation with your submission.  Requests submitted without documentation cannot be reviewed until the information is provided.


Supporting documents may include but are not limited to:
 
  • Clinical notes or medical records
  • Itemized statements
  • Coordination of Benefits (COB) documentation
  • Prior Authorization information
  • Any other documentation necessary to fully evaluate the claim

What Is Considered to be a Claim Dispute?

A claim dispute includes, but is not limited to:

  • Disagreement with claim payment or denial 
  • Requests for reconsideration or adjustment
  • Contractual or pricing-related disputes
  • Claims processed incorrectly based on submitted documentation

 

Note: Claim disputes are different from formal appeals. A formal appeal applies to a denied pre-service.
For information regarding how to submit documentation in Plan Central, please click here.
 
If you have any questions, contact Provider Support Services via email at contactproviderservices@summacare.com or Provider Engagement at providerengagement@summacare.com.
 

Questions? We are here to help.

Provider Support Services

By Phone:

330.996.8400 (TTY 711)

or

800.996.8401 (TTY 711)

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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