SummaCare

Resources & Self Service

At SummaCare, we want to make it easy for you to provide quality care to our members! In this section you’ll find online tools, downloadable forms and information to help you do business with us.

Self Service Tools

Plan Central
Log in to Plan Central to view patient eligibility, benefits, claims status and self-funded prior authorization lists.

New user? Request access to Plan Central.

Claim Check
Log in to Clear Claim Connection to review clinical edits and clarification.

New user? Request access to Clear Claim Connection.

Forms

• Coordination of Care Form
• Claim Adjustment Requests
• NPI Submission Form
• Prior Authorization Fax Form
• Become a Network Provider
• EDI Registration
• Provider Change of Information Form

Resources

• Prior Authorization  -SummaCare utilizes one prior authorization list for all fully-insured PPO/POS/HMO and Medicare (Secure) plans. To view prior authorization lists for self-funded groups, please visit Plan Central    and click on "Related Documents" after logging in.
• Clinical Practice Guidelines -SummaCare’s clinical guidelines include recommendations, strategies and other information to assist healthcare professionals in making decisions about appropriate healthcare for specific conditions.
• Provider Search -Search SummaCare’s provider network.
• Provider Manual -To request a hard copy,  email contactproviderservices@summacare.com.
• Member Rights and Responsibilites

Contact Us

If you have questions, email contactproviderservices@summacare.com.