Summit Community Care Provider Home

Providers

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.

Provider Relations Assignments

Clinical Criteria Web Posting September 2019

On September 19, 2019, the Pharmacy and Therapeutics (P&T) Committee approved the following Clinical Criteria applicable to the medical drug benefit for Anthem Blue Cross. These policies were developed, revised or reviewed to support clinical coding edits.

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.

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.