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Medical Management Policies

SummaCare Commercial Inpatient Authorization Policy

Guidelines for Coverage Determination:

  1. To be compliant with our request for timely notification, it is necessary for you to notify SummaCare of ALL hospital admissions within one business day. This is inclusive of elective, emergent and OB hospitalizations.  

  2. SummaCare determinations are based on, but not limited to:
  • Policy Notifications on the SummaCare Website
  • CMS National Coverage Determinations and Medicare Benefit Policy Manual
  • InterQual Criteria/Guidelines
  • NCCN Guidelines

Questions?  We are here to help.

Provider Support Services

By Phone:

By Email:

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.