SummaCare Provider Portal: Secure Access for Healthcare Providers

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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

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

  1. Visit the Plan Central homepage
  2. Click on the registration link
  3. Complete the registration process
  4. Request access for the portal

Contact for Access

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

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