Summit Community Care Provider Home


Welcome, providers!

On this site, you will find resources that help health care professionals do what they do best — care for our members.

Are you interested in joining our network? We look forward to working with you to provide quality services to our members.

Provider news

Here you will find the latest articles and announcements on claims filings, products, benefits, administrative updates, new and revised procedures and guidelines, prescription information, and more.

Prior authorization requirements changes effective November 1, 2019

Effective November 1, 2019, prior authorization (PA) requirements will change. These services will require PA by Summit Community Care for Medicaid members

Claim Payment Dispute Process

We are in the process of updating the Summit Community Care provider manual to include information on how providers can submit claim payment disputes through the Availity Portal, as well as some additional information on the process.

Prior Authorization - Transitional Authorization Period

Summit Community Care is implementing Transitional Authorization Waver Period for BH Outpatient, HCBS, Speech/Occupation/Physical Therapies, Personal Care and Medical Outpatient service through October 31, 2019.

Third Party Liability (TPL) Information

Read this policy information about how to submit a claim where third party liability exists.

Availity access

At Availity you can:

Request Authorizations
Submit Claims
Confirm Eligibility

If you don't have an Availity account, you can register for free now!

Availity is your one-stop to complete your transactions

Featured resources

Pharmacist looking at prescription bottle

Pharmacy information

Search for up-to-date drug information, including hundreds of brand-name and generic medications.

Expectant mother sharing ultrasound

Maternal Child Program

We offer a proactive case management program for expectant mothers and their newborns. The My Advocate™ program provides pregnant women proactive outreach and education through Interactive Voice Response (IVR), text or smartphone application.

Caring therapist counseling patient

Behavioral health providers

We work collaboratively with hospitals, group practices and independent behavioral health care providers, community and government agencies, human service districts, and other resources to successfully meet the needs of members with behavioral health and substance use needs, as well as those with intellectual and developmental disabilities.

Provider tools & resources

Interested in becoming a provider in the Summit Community Care Network?

We look forward to working with you to provide quality service for our members.