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.