SummaCare provider portal, phone and payer ID quick facts
| Provider resource entry point | https://www.summacare.com/plancentral |
|---|---|
| Payer contact reference | 1-800-996-8401Provider Support Services lists 800-996-8401, not baseline 800-996-8701. |
| Claims payer ID | 95202 — Fully-funded claims only; resolve self-funded source conflict with EDI support. |
| Eligibility payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| ERA payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately. Clearinghouse-specific: This registry has not established one national ERA payer ID for SummaCare. ERA enrollment and 835 routing are clearinghouse- and product-specific; verify in the payer portal or clearinghouse payer list before enrollment. |
| Timely filing | Initial claims: 365 days from service |
| Prior auth route | Verify the current product policy and delegated reviewer; X12 278 support is not established by a portal link |
| Last reviewed | 2026-04-23 |
- Provider Support Services lists 800-996-8401, not baseline 800-996-8701.
- The provider FAQ states 365 days from the service date. Confirm the member product and any controlling contract exceptions; this reference does not supply a separate appeal or corrected-claim deadline.
- This registry has not established a payer-specific appeal ladder for SummaCare. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
- This registry has not established one national ERA payer ID for SummaCare. ERA enrollment and 835 routing are clearinghouse- and product-specific; verify in the payer portal or clearinghouse payer list before enrollment.
SummaCare at a glance
| Legal name | SummaCare Inc. |
|---|---|
| Also known as | Summa Care, Summa Health Plan |
| Category | Commercial |
| Parent organization | Summa Health |
| Claims payer ID | 95202 — Fully-funded claims only; resolve self-funded source conflict with EDI support. |
| Eligibility (270/271) payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| ERA (835) payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately. Clearinghouse-specific: This registry has not established one national ERA payer ID for SummaCare. ERA enrollment and 835 routing are clearinghouse- and product-specific; verify in the payer portal or clearinghouse payer list before enrollment. |
| NAIC company code | Not established in this registry |
| States covered | Ohio |
| Provider resource entry point | https://www.summacare.com/plancentral |
| Provider phone | 1-800-996-8401Provider Support Services lists 800-996-8401, not baseline 800-996-8701. |
Always verify claims-routing details against the member ID card and the payer's current EDI companion guide before submission.
Timely filing & appeals for SummaCare
The provider FAQ states 365 days from the service date. Confirm the member product and any controlling contract exceptions; this reference does not supply a separate appeal or corrected-claim deadline.
| Submission type | Window |
|---|---|
| Initial claim reference | Initial claims: 365 days from service |
| Out-of-network initial claim | Verify the member's plan and applicable out-of-network rules |
| Secondary / coordination of benefits | Verify the allowed window and start event; a primary EOB does not automatically restart filing |
| Corrected claim | Verify correction instructions; do not substitute an appeal deadline |
| Reconsideration / appeal | Use the applicable denial or decision notice and the process below |
This registry has not established a payer-specific appeal ladder for SummaCare. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
Source: SummaCare provider policy. Always confirm before disputing a TFL denial — payer policies are versioned and product-specific.
Prior authorization with SummaCare
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
CMS-0057-F decision-timeframe requirements and exclusions
Verify SummaCare electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable. Authorization requirements and submission channels depend on the product, service and delegated reviewer. Verify the applicable policy before scheduling; a portal listing is not proof of X12 278 connectivity.
This registry does not provide a current prior-authorization code list for SummaCare. Start with the provider resources or the policy documents below, then confirm the applicable product, service and effective date. A resource link does not establish that a live code-lookup tool is available.
Top denial reasons for SummaCare
Per-payer denial benchmarks publish here once the QuickIntell anonymized ETL pipeline ingests sufficient SummaCare volume. Until then, see the broader CARC reference for industry-wide remediation guides.
Electronic claims, eligibility & ERA
| Transaction | Registry indication — not verification | Routing reference |
|---|---|---|
| 837P / 837I claims | Listed in registry; verify current scope | 95202 — Fully-funded claims only; resolve self-funded source conflict with EDI support. |
| 270 / 271 eligibility | Listed in registry; verify current scope | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| 278 prior authorization | Listed in registry; verify current scope | Verify X12 278 routing separately |
| 835 ERA | Verify support and enrollment separately | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately. Clearinghouse-specific: This registry has not established one national ERA payer ID for SummaCare. ERA enrollment and 835 routing are clearinghouse- and product-specific; verify in the payer portal or clearinghouse payer list before enrollment. |
Payer IDs vary by clearinghouse — confirm against your clearinghouse payer list (Availity, Change Healthcare/Optum, Waystar) before configuring submitter routing.
Source checks and remaining limits
The latest partial comparison is dated . Retained earlier findings keep their original dates below. This is a partial source check, not a whole-page, clinical or legal review. It does not refresh the legacy review date above.
portal_url
Source comparison: 2026-09-26
The provider FAQ directs claim status, eligibility and EOP access to Plan Central.
Primary source for portal_urlprovider_phone
Source comparison: 2026-09-26
Provider Support Services lists 800-996-8401, not baseline 800-996-8701.
Primary source for provider_phonepayer_ids.claims
Source comparison: 2026-09-26
The HTML FAQ supports 95202 for fully-funded plans. Self-funded IDs conflict across official materials (HTML34916 versus BH-manual search text 34196), so no self-funded numeric proposal.
Primary source for payer_ids.claimselectronic_claims_supported
Source comparison: 2026-09-26
The provider FAQ documents electronic clearinghouse submission.
Primary source for electronic_claims_supportedtimely_filing_days
Source comparison: 2026-09-26
Provider FAQ specifies 365 days from service; contract/product exceptions still require their controlling documents.
Primary source for timely_filing_days
Not checked in this pass: Whole-record approval, legal identity, ownership and complete product coverage; Authenticated transactions and QuickIntell integrations; payer_ids.eligibility / payer_ids.era / era_payer_id / supports_279_271 / supports_278: Portal eligibility/EOP and a claim ID do not prove transaction-specific identifiers or X12 eligibility/278 capability..
Sources used for this guide
State coverage
SummaCare operates in the following states. Each link opens state-level Medicaid program details, dominant commercial payers, and state-specific RCM regulations.
Evaluate QuickIntell workflow fit for SummaCare
These module references are evaluation starting points, not evidence of a validated connection, supported transaction or customer deployment. Confirm the actual member plan, data access and product scope first.
- QuickRCM
Evaluate claim preparation, follow-up and denial worklists for SummaCare; verify the actual plan rules and available connections before implementation.
- QuickAuth
Assess authorization-packet and status workflows for SummaCare; confirm product, service, delegated reviewer and permitted submission channels.
- QuickERA
Verify the actual 835 files, posting exceptions and reconciliation requirements for SummaCare before evaluating automation. An ERA identifier alone does not establish supported ingestion or posting.
Frequently asked questions about SummaCare
Where is the SummaCare provider portal?
Use https://www.summacare.com/plancentral as a starting point for SummaCare provider resources. This link may open a directory or contact page rather than a transaction portal. Select the applicable product and administrator, then verify the available functions, enrollment and access requirements. QuickIntell is not the official payer portal.
What is the timely filing limit for SummaCare?
The provider FAQ states 365 days from the service date. Confirm the member product and any controlling contract exceptions; this reference does not supply a separate appeal or corrected-claim deadline.
Does SummaCare publish a single claims payer ID?
This registry has not established one all-product claims payer ID for SummaCare. Claims: 95202 — Fully-funded claims only; resolve self-funded source conflict with EDI support.. Eligibility (270/271): No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately. ERA (835): No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately. Clearinghouse-specific: This registry has not established one national ERA payer ID for SummaCare. ERA enrollment and 835 routing are clearinghouse- and product-specific; verify in the payer portal or clearinghouse payer list before enrollment.. Do not substitute a claims ID for an unverified transaction ID. Look up the correct ID for the member's plan and transaction in your clearinghouse directory and verify against the member ID card before submission.
Does SummaCare accept electronic claims?
Verify SummaCare electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable.
How do I appeal a SummaCare denial?
This registry has not established a payer-specific appeal ladder for SummaCare. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
How long do SummaCare prior authorization approvals take?
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
What is the SummaCare provider phone number?
This registry lists 1-800-996-8401 as a contact reference for SummaCare. Provider Support Services lists 800-996-8401, not baseline 800-996-8701.
Automate workflows around SummaCare requirements
Connect eligibility, prior authorization, pre-submission claim checks, and remittance routing in one governed workflow. Payer and plan configuration is confirmed during implementation.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. Payer policies change without notice — always verify against SummaCare's current published documents before submission. CPT® is a registered trademark of the American Medical Association.