Navigating the prior authorization process in healthcare can be complex. If you’re a healthcare provider working with Summit Community Care and need to determine if a service or medication requires pre-authorization, you might be wondering: Does Summit Community Care have an auth pre-check tool? The answer is yes, Summit Community Care utilizes an efficient online tool to streamline this process for providers.
Utilizing Availity’s Interactive Care Reviewer (ICR) for Authorization Checks
Summit Community Care leverages the Interactive Care Reviewer (ICR) tool, accessible through the Availity provider portal, as their primary method for handling prior authorization requests and inquiries. This online tool allows healthcare providers to quickly submit and check the status of prior authorizations.
To access the ICR tool, you will need an Availity account. If you are already registered with Availity, simply log in and navigate to Patient Registration | Authorizations & Referrals. From there, you can select either Authorizations to initiate a new request or Auth/Referral Inquiry to check the status of an existing one.
For providers who do not yet have an Availity account, registration is free and can be completed at the Availity provider portal registration page. If you require assistance with Availity, Summit Community Care offers resources to help you learn more about using the platform.
Alternative Prior Authorization Methods
While the Availity ICR tool is the recommended online method, Summit Community Care provides alternative options for prior authorization requests to accommodate different needs and situations. These alternatives primarily involve fax submissions for specific service categories.
Physical Health Services
For physical health services, if you are unable to use the Availity portal, you can download and complete the Prior Authorization Form. Once completed, this form should be faxed to 1-800-964-3627 for processing.
Behavioral Health Services
Certain behavioral health services require prior authorization, particularly those billed under specific revenue codes. These revenue codes include:
- 0240–0249 — All-inclusive ancillary psychiatric
- 0901, 0905–0907, 0913, 0917 — Behavioral health treatment service
- 0944–0945 — Other therapeutic services
- 0961 — Psychiatric professional fees
For behavioral health services requiring fax submission, please use the following fax numbers:
- Inpatient: 1-877-434-7578
- Outpatient: 1-866-877-5229
You can find relevant forms for fax submissions on the Forms page.
Pharmacy Services
For pharmacy services, it’s essential to consult the Preferred Drug List (PDL). Services billed under revenue code 0632 — Pharmacy multiple sources always require prior authorization. While most medications on the PDL do not require prior authorization, some exceptions exist, necessitating contact with the Pharmacy department for authorization.
Long-Term Services and Supports
For long-term services and supports, providers should initiate the authorization process by calling 1-844-462-0022. Prior authorization is always required for elective services at nonparticipating facilities and for services billed under these revenue codes:
- 0023 — Home health prospective payment system
- 0570–0572, 0579 — Home health aide
- 0944–0945 — Other therapeutic services
- 3101–3109 — Adult day and foster care
Additional Prior Authorization Resources
Summit Community Care offers several resources to further assist providers with the prior authorization process:
- Prior Authorization Criteria: Link to Prior Authorization Criteria
- Prior Authorization Lookup Tool: Link to Prior Authorization Lookup Tool
- Prior Authorization Forms: Link to Prior Authorization Forms
- Preferred Drug List (PDL): Link to Preferred Drug List
- Pharmacy Information: Link to Pharmacy Information
By utilizing the Availity ICR tool and understanding the alternative methods and resources available, healthcare providers can efficiently manage prior authorizations with Summit Community Care, ensuring timely access to necessary services for patients.
