Specialty Pharmacy provider for most commercial and all marketplace members. Providers may call AcariaHealth.
First level chart retrieval and chart coding.
Amplifon Hearing Health Care
Provides hearing exams and fitting of hearing aids. Providers may contact Amplifon on behalf of SummaCare members.
Birdi (MedImpact Direct Mail)
SummaCare’s mail-order pharmacy partner.
Home-based palliative care which provides support to seriously ill members and their families.
Post-claim audit reviews.
Mailing Address: 16350 Bake Parkway, Irvine, California 92618
Reviews and determines medical necessity on requests submitted by providers for High-Tech radiology, Medical Oncology, Radiation Therapy and Genetic Lab tests. eviCore may reach out telephonically, or more likely by fax or letter.
Out-of-state members or urgent/emergent out of network all others
Offers members durable medical equipment (DME) supplies and equipment, including preferred diabetes testing supplies, for all SummaCare members per benefit. Including the following Medicare plan benefits: home safety devices, non-medical transportation/ride-share, massage therapy/acupuncture and air purifiers, if selected on Jade (HMO) as part of Tier 2 Bene-Flex™.
Performs member in home health assessments.
Medical Advantage Group (MAG)
Offers high-touch provider training on risk adjustment and gap closure. Contact your Provider Engagement Specialist for more information.
Third level chart retrieval and chart coding
Medtronic Care Management Services
In-home remote monitoring of symptoms and biometric readings of members with chronic conditions. Providers will receive fax/call when member is trending outside of recommended ranges.
Medtronic RN Team
Ohio Health Choice, Ohio PPO Connect
Urgent/emergent care in Ohio outside of network.
Subrogation or third-party liability vendor
Medication Therapy Management (MTM). Offers qualified members a Comprehensive Medication Review (CMR) and conducts Targeted Medication Reviews (TMR) at least quarterly.
Offers eligible members in-home heel bone density scans, diabetes retinal eye exams and colorectal cancer screening FIT (fecal immunochemical test) kits.
Press Ganey (formerly SPH Analytics)
Administers surveys to our members, including those required by CMS. These surveys help SummaCare evaluate and improve services and programs.
SummaCare Case Management
Home visits for members who meet criteria for chronic care needs with ambulatory sensitive conditions.
Summa Bridge to Home
Support during transition back to the PCP after an inpatient hospitalization.
Trend Health Partners
Claim and credit balance review.
Wolters Kluwer Health
Second-level chart retrieval and chart coding.
NSA - No Surprise Act