Joining our network is easy!
We’re glad to hear that you are interested in joining us! We have a diverse network of exceptional health care professionals that help ensure our members have uninterrupted access to the health care they need.
Vision, pharmacy and hearing providers: Please contact our vendor websites linked on our Benefits partners page for networking information.
All other providers: Use the steps below to begin the process.
You make your patients' lives better. We'll do the same for you.
Our prior authorizations, referrals, claims and payment processes are streamlined to help you focus on what you do best — caring for your patients.
We support you with:
- A coordinated approach to care with innovative patient outreach/education
- Disease and case management resources
- Patient centered medical home transformation
- Online self-service tools and live-agent support
- Local Provider Relations staff committed to your success
The contract & credentialing process
Network participation request
Our contracting and credentialing process is easy. Download the required documents and email them to ARProviderDocuments@Summitcommunitycare.com
The credentialing process
A network development representative will contact you to discuss an agreement and to review the documents submitted.
Provider setup
After passing credentialing and executing an agreement, you'll be configured in our system and listed in the provider directory.
Required forms and documents
To ensure timely processing of your request, please download and submit all forms.
Submit documents to: Providers@summitcommunitycare.com.
Note: Be sure to include the provider's name and NPI in all email correspondence.
Credentialing with Summit Community Care
Credentialing is the process Summit Community Care uses to evaluate and select licensed, independent practitioners to provide care to our members. Summit Community Care uses the Council for Affordable Quality Healthcare (CAQH) ProView application for credentialing. This secure and private website reduces the amount of paperwork you need to fill out to complete the credentialing process.
Credentialing Overview
Why do we credential?
Credentials are evaluated according to criteria set forth in our policy to ensure the competency and conduct of the healthcare professionals serving members in our network.
Who do we credential?
We credential licensed healthcare professionals with whom the company intends to contract and market to our members. Our Program Summary includes a complete list of provider types we credential and those we do not.
Please note: Facilities (health delivery organizations) may also need to be credentialed before joining the network.
Credentialing Process
1. Register with CAQH (if you are not already registered). You may self-register by visiting proview.caqh.org. This is a secure and private website.
2. Authorize Summit Community Care so we can access your credentialing information. If you are already registered with CAQH, you will need to give us permission to review your information.
3. If you need assistance, please review the Provider Reference Guide or call the CAQH Provider help line at 888-599-1771.
4. Review and update your application. Please ensure all sections of the application are complete and accurate.
Credentialing application requirements
The credentialing process typically takes 45 days from the time the credentialing department receives your completed CAQH application.
A complete application includes:
- Your signature and application date
- CAQH status of Initial Application Complete or Reattestation
- Current license to practice in each state where services are provided
- Education/training to support requested specialty(ies) (or documentation that provider will complete training within 60 days of application)
- Current hospital privilege information
- Current DEA or CDS certificate in each state where services are provided
- Explanations to questions on the application
- Five years’ work history in month/year format
- Current professional liability insurance
- Applicant must also allow a site review within 30 days of our request, if applicable
Recredentialing
Summit Community Care recredentials network providers every three years. If your CAQH application is current and complete at that time, no additional effort on your part may be required. If CAQH is expired or missing information, we will contact you to update the information.
Non-response to recredentialing request
If you do not update CAQH or supply the required information for recredentialing by the due date, your application will be considered incomplete and will result in an administrative termination from the network.
Provider rights
Providers have the right to:
- Review the information submitted to support their credentialing application.
- Correct erroneous information.
- Receive the status of their credentialing or recredentialing application upon request.
For a complete list of your credentialing rights as a provider, please review the Practitioner Credentialing Rights. To review your application or correct submitted information, please email our credentialing team at: Credentialing@summitcommunitycare.com.