Claims Processing Policies

If a provider office prefers take backs be done on all overpaid claims, a signed letter on office letterhead agreeing to take backs across the board should be submitted to SummaCare. This would apply to all overpayments pending and in the future. Providers are not notified in advance of the take back.

A refund request letter will be sent in the event the overpayment is not recouped within 90 days.

Please send the above mentioned letter of agreement to:
SummaCare Insurance Company
Attention: Recovery
1200 East Market Street, Suite 400
Akron OH 44305

Beginning October 1, 2020, paper overpayment requests for providers who have not agreed to take backs will be sent once. Overpayments not refunded within 30 days, will be recouped from future claims.

Any questions regarding the take back process should be directed to Provider Support Services at 330.996.8400 or 800.996.8401. Providers may also email questions to contactproviderservices@summacare.com.

• Drugs and Biologicals - JW and JZ Modifier Policy
• Radiopharmceuticals
• Anesthesia Claim Payment
• Claim Payment to Non-Contracted Providers for Medicare
• Exclusion Screening for Providers
• Hospice Services Medicare
• Interest Payments Medicare Plans
• Medicare Explanation of Benefits and Denial Notices
• Medicare Explanation of Payments Template
• Medicare Member Claim Reimbursement
• Medicare Payment Policy  - Refractions
• Medicare Provider and Beneficiary Notification Paper and Electronic
• Medicare Remittance Notice for Non-Contracted Providers
• Monitoring of Medicare Prompt Payment of Claims
• Multiple Error Overpayment Recovery
• Multiple Procedure Payment Reduction (MPPR) for Diagnostic Imaging
• Multiple Procedure Payment Reduction (MPPR) for Physical Therapy
• Overpayment Recovery Procedures Revised
• Payment for Plan Directed Care
• Payment Policy - Modifier 25
• Processing of Claims During the Grace Period
• Prompt Payment of Claims - Fully-Insured, Marketplace and MEWA
• Prompt Payment of Claims - Medicare
• Provider Claims Submission and Adjustment Filing for Medicare Plans
• Provider Preclusion Process
• Subrogation Policy
• Void and Stale Dated Check Procedures
• Waiver of Liability Statement