The SummaCare Provider Portal, known as Plan Central, is a comprehensive online platform designed to streamline healthcare provider interactions and access critical information. This digital tool offers healthcare professionals a centralized system for managing patient-related tasks and accessing essential resources.
Official Links
- Primary Website: https://www.summacare.com/providers
- Claims Information: https://www.summacare.com/providers/provider-resources/claims
What Providers Can Do
Providers using the SummaCare Portal can:
- View patient eligibility
- Check benefits
- Review claims status
- Access self-funded prior authorization lists
- Review clinical edits and clarifications
How to Access the Portal
Registration Process
- Visit the Plan Central homepage
- Click on the registration link
- Complete the registration process
- Request access for the portal
Contact for Access
- Provider Support Services
- Phone: 330.996.8400 or 800.996.8401
- Email: [email protected]
Key Features
Claim Management
- Submit claim adjustment requests
- View claim details
- Understand claim edit rationales
Billing Guidelines
- Medicare Advantage members: Bill as you would traditional Medicare
- Commercial members: Follow industry standard guidelines
Important Billing Notes
SummaCare emphasizes:
- Include all Medicare reimbursable codes
- Use applicable modifiers
- No dispute process for code edit inquiries
Provider Support
Provider Engagement Specialists
- Offer in-office training
- Address authorization processes
- Assist with claims issues
- Explain SummaCare products/benefits
- Provide Plan Central training
Privacy and Compliance
Reporting Compliance Concerns
Providers can report:
- Suspected misconduct
- Code of Conduct violations
- HIPAA regulation concerns
- Fraud or abuse issues
Reporting Methods
- Compliance Hotline: 330.996.8821 or 800.361.3908
- Mail: SummaCare, Compliance Officer, P.O. Box 3620, Akron, OH 44309-3620
- Email: [email protected]
Unprovided Information
The available documentation does not specify:
- Exact mobile app availability
- Detailed login screen process
- Specific portal interface design
- Complete feature list
Additional Resources
Providers can access:
- Clinical Practice Guidelines
- Quality Management Information
- Provider News
- Health Services Information
The SummaCare Provider Portal (Plan Central) offers a comprehensive, secure platform for healthcare providers to manage patient information, claims, and administrative tasks efficiently.
Contact Information
- Address: 1200 East Market Street, Suite 400, Akron, OH 44305-4066
- Provider Support: [email protected]
- General Phone: 330.996.8400
Note: Always verify the most current information directly with SummaCare, as portal features and access methods may evolve.
https://www.summacare.com/providers/provider-resources/claims
The Provider Portal will help you obtain explanations for claim edits at your convenience. Questions? We are here to help.
https://www.summacare.com/providers
Our Provider FAQs page offers clear guidance on joining SummaCare’s network, updating practice information, navigating claims, billing and authorization