SummaCare follows all Centers for Medicare and Medicaid Services (CMS) and applicable state rules and regulations pertaining to all Medicare Advantage Plans. SummaCare reserves the right to modify its policies as necessary. Policies found on this website are provided for informational purposes. It does not constitute medical advice or guarantee of payment.
2025 Prior Authorization
2025 UM Policy
Access to Behavioral Healthcare Services Policy
Acute Concurrent Inpatient Review and Discharge Planning Process Policy
Authorization Approval and Denials
Authorization Audit and Monitoring
Authorization Exception Policy
Clinical Certification of Services-Medicare Advantage
Complex Case Management Program Documentation and Outreach
Coverage for Out-of-Network Service Requests Policy
Coverage of Emergency Services Policy
DDMI-Utilization Management Committee Procedure
Durable Medical Equipment Authorizations Policy
Evaluation of Prior Authorization Process and the Implementation and Communication of Changes
Evicore Healthcare 2024 Utilization Management Program Description
Follow-up after Hospitalization for Mental Illness
Heart Transplant Rejection
Hospice
Non-Complex Case Management Outreach and Documentation Procedure
Pre-Service Organization Determinations
Primary Care Physician Empanelment
Provision of Criteria
Retrospective Review of Services
Skilled Nursing Facility Provider Authorizations
Skilled Nursing Facility Services
Transition to Other Care when New on Plan or Network Changes
Transplant Travel Policy – Medicare Advantage
UM Notification Letter Processing
Urgent Care Services Policy
Utilization Committee Charter Policy