AcariaHealth
Specialty Pharmacy provider for most commercial and all marketplace members. Providers may call AcariaHealth.
Phone:
855.422.2742 or
833.626.8417 (
711)
AdvantMed
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.
Phone:
800.920.4327 (TTY
711)
Birdi (MedImpact Direct Mail)
SummaCare’s mail-order pharmacy partner.
Website:
medimpact.com
Phone:
855.873.8739 (TTY
711)
CareCentrix
Home-based palliative care which provides support to seriously ill members and their families.
Email:
palliativereferrals@carecentrix.com
Phone:
234.867.7015
Catalyst
Post-claim audit reviews.
Fax:
1.855.237.4143
Mailing Address: 16350 Bake Parkway, Irvine, California 92618
everlywell
Provides and processes in-home tests, such as colorectal cancer screening FIT (fecal immunochemical test) kits to select members. Providers will receive a fax if a member’s results are positive.
Website:
membersupport.everlywell.com
Phone:
1.855.923.2678 (TTY
711)
eviCore
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.
Phone:
855.774.1315
Fax: 800.542.2406
First Health
Out-of-state members or urgent/emergent out of network all others
Website:
firsthealth.com
Phone:
800.937.6824
HOMELINK
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™.
Phone:
844.358.2549
Matrix
Performs member in home health assessments.
Phone:
1.855.561.7335
Medical Advantage Group (MAG)
Offers high-touch provider training on risk adjustment and gap closure. Contact your Provider Engagement Specialist for more information.
MedKoder
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.
Referrals
Email:
casemanagement@summacare.com
Phone:
877.888.1164
Medtronic RN Team
Email:
pass@medtronic.com
Phone:
866.581.3897
Ohio Health Choice, Ohio PPO Connect
Urgent/emergent care in Ohio outside of network.
Website:
ohiohealthchoice.com
Phone:
800.554.0027
Optum
Audit review
Phone:
877.787.2310
Fax: 781.240.0509
Subrogation or third-party liability vendor
Email:
submitreferrals@optum.com
Phone:
800.418.6966
OutcomesMTM
Medication Therapy Management (MTM). Offers qualified members a Comprehensive Medication Review (CMR) and conducts Targeted Medication Reviews (TMR) at least quarterly.
Phone:
855.905.4689
Quest HealthConnect
Offers eligible members in-home heel bone density scans and diabetes retinal eye exams.
Phone:
844.200.2183
Referrals:
casemanagement@summacare.com
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.
Email: casemanagement@summacare.com
Phone: 877.888.1164
Summa Bridge to Home
Support during transition back to the PCP after an inpatient hospitalization.
Email:
casemanagement@summacare.com
Phone:
877.888.1164
Trend Health Partners
Claim and credit balance review.
Email:
sboots@trendhealthpartners.com
Phone:
443.591.5633
Wolters Kluwer Health
Second-level chart retrieval and chart coding.
Zelis
NSA - No Surprise Act
Email:
nsa@zelis.com
Phone:
888.266.3035
Out-of-network vendor
Phone:
866.489.9444
