Specialty Pharmacy provider for most commercial and all marketplace members. Providers may call AcariaHealth.
Phone: 855.422.2742 or 833.626.8417 (711)
First level chart retrieval and chart coding.
Provides hearing exams and fitting of hearing aids. Providers may contact Amplifon on behalf of SummaCare members.
Phone: 800.920.4327 (TTY 711)
SummaCare’s mail-order pharmacy partner.
Website: medimpact.com
Phone: 855.873.8739 (TTY 711)
Home-based palliative care which provides support to seriously ill members and their families.
Email: palliativereferrals@carecentrix.com
Phone: 234.867.7015
Post-claim audit reviews.
Fax: 1.855.237.4143
Mailing Address: 16350 Bake Parkway, Irvine, California 92618
Cigna Healthcare PPO network for coverage outside of Ohio for out of state members or urgent/emergent out of network all others.
Website: www.cigna.com
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
Offers members durable medical equipment (DME) supplies and equipment, including preferred diabetes testing supplies, for all SummaCare members per benefit.
Phone: 844.358.2549
Performs member in-home health assessments.
Phone: 1.855.561.7335
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
Urgent/emergent care in Ohio outside of network.
Website: ohiohealthchoice.com
Phone: 800.554.0027
Audit review
Phone: 877.787.2310
Fax: 781.240.0509
Subrogation or third-party liability vendor
Email: submitreferrals@optum.com
Phone: 800.418.6966
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
Offers eligible members in-home heel bone density scans, diabetes retinal eye exams and colorectal cancer screening FIT (fecal immunochemical test) kits.
Administers surveys to our members, including those required by CMS. These surveys help SummaCare evaluate and improve services and programs.
Home visits for members who meet criteria for chronic care needs with ambulatory sensitive conditions.
Email: casemanagement@summacare.com
Phone: 877.888.1164
A digital musculoskeletal and pelvic healthcare provider that combines licensed clinicians with AI-powered technology to deliver personalized, at-home physical therapy and preventive care, reducing surgeries and healthcare costs.
Website: meet.swordhealth.com/summacare
Claim and credit balance review.
Email: sboots@trendhealthpartners.com
Phone: 443.591.5633
Second-level chart retrieval and chart coding.
NSA - No Surprise Act
Email: nsa@zelis.com
Phone: 888.266.3035
Out-of-network vendor
Phone: 866.489.9444