Medical Management Policies and Guidelines

SummaCare Commercial Inpatient Authorization Policy

Guidelines for Coverage Determination:

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.
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

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Provider Support Services

By Phone:
330-996-8400
or
800-996-8401

By Email:
contactproviderservices@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.

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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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