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Vendors Serving SummaCare Providers

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
 

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