Summit is primarily a tool for administering group benefits. As such, it offers extensive employer management capabilities to administrators. The Employer page serves as an umbrella for accessing the demographics and settings particular to your employer clients as well as allowing you to manually add and configure new employer groups. The Employer page and its … Read More >>
Bank Accounts details are necessary at the Employer level for the system to function properly on claim reimbursement, settlement of debit card transactions, etc. A user can create, edit, and view Employer-level Bank Accounts. If needed, users can also terminate accounts from the Employer Bank Accounts tab. * Required fields appear in Red To access Employer … Read More >>
Benefit Orders are arrangements created by the TPA to arrange the Employer Plans associated with specific Service Categories and Codes created by the TPA and to enhance the claim entry process for auto-selecting the appropriate Plan during claim entry. Benefit Order determines the priority logic by which plans will attempt to reimburse participants for the … Read More >>
Employers can be viewed, modified, or added from the main screen of Employer Central. Once an Employer has been selected from the Employer Central screen, the Employer’s Primary Demographic information and Active Plans information will display at the top of the page with the different Employer tabs below. The Demographics tab will be open by … Read More >>
Users are able to create, view, and modify employer-level benefit plans from the Employer | Benefit Plans tab. To configure Employer-level benefit plans: Adding a Plan The user can create new Benefit Plans, using the +Add Plan link. For information on adding employer plans, see: Group Plan Administration Summit users are able to select a … Read More >>
Summit allows for TPAs/employers to issue employee participants and their covered spouse/dependents debit cards that are linked to their plan benefits for easy access to their plan dollars. The Cards tab of Employer Central allows you to enable an Employer for card issuance and processing and also associate them with card settings and a Card … Read More >>
The Demographics tab of the Employer Central allows for the input of basic address information and other vital statistics and information pertaining to the employer that is not covered in the Primary Demographic information. * Required fields appear in Red Summit will default to the Demographics tab when a user accesses Employer Central and selects an … Read More >>
Employer Division, Location, and Union creation or modification are done through Employer Central. These details can be created either through wizards or manually. This is an optional step whereby the TPA may indicate if there are any divisions or locations or Unions of an Employer, as well as whether or not processing and configurations and … Read More >>
Summit allows users to manage and configure Health Plans for Employer Groups. Users can create, edit and view Employer Health Plans and link participants with the health plans created in Summit. The “Health Plans” tab is located between the “Cards” and “Premium Billing” tabs in the Employer Central page. * Required fields appear in Red To … Read More >>
Schedules are pre-defined processes that are used to generate or post Contributions, Remittances, Premium Auto Drafts in batches or to create billing for Direct Bill Premium Billing coverages. The Schedules tab consists of a Contribution Schedules section, a Remittance Schedules section, a Premium Auto-Draft Schedules section, and a Billing Schedules section. A user can add, … Read More >>
Summit allows the user to enter Employer details by two ways – Manually and via the Wizard. Employer Central Wizard allows the user to enter and save various Employer details such as Demographics, Employer Settings, Benefit Settings, Card Package and Alerts. The wizard is designed to help the user easily set up a new Employer … Read More >>
Reimbursement is a process of paying money to Participants for the out-of-pocket expenses for an eligible service or product. The purpose of the Employer Reimbursement Settings page is to configure default values at the Employer level that will drive the reimbursement process. A user can view and edit Reimbursement Settings for specific employers on this … Read More >>
Summit allows the user to manage the banking information and settings for the Reimbursement at the employer level. The banking information necessary to facilitate the money movement for reimbursement is configured on the Banking/Checking tab of Employer| Reimbursement Settings. * Required fields appear in Red To access Employer Reimbursement Banking/Checking, This section is divided into several sub-sections. … Read More >>
Reimbursement is an act of paying money to Participants for the out-of-pocket expenses they had spent over an eligible service or product. The purpose of the Employer Reimbursement Communications tab is to configure default values at the Employer level that will drive the reimbursement communication process. The communications tab contains the settings for how Summit … Read More >>
There are several ways to enter a claim in Summit — Manual entry by TPA, participant entry through the Participant Portal or the Mobile App, via claim import, by debit card swipe, etc. In some cases, a claim may be submitted multiple times by multiple means. Summit offers Duplicate Claims detection logic to find and … Read More >>
Reimbursement is a process of paying money to Participants for the out-of-pocket expenses they had spent over an eligible service or product. The purpose of the Employer Reimbursement Settings page is to configure default values at the Employer level that will drive the reimbursement process. General Settings is the default tab that opens up when … Read More >>
Reimbursement Schedules are pre-defined processes that are used to generate or post the Reimbursements in batches. A user can add, edit and view created schedules in the Schedules tab of the Employer Reimbursement Settings Page. * Required fields appear in Red To access Employer Reimbursement Schedules, Go to Employer. Select the Reimbursement Settings menu. Select the … Read More >>
Summit users are able to select a plan and move all participants from one or more selected tiers of the plan to another tier of the same plan and plan year (if applicable). This allows users to effectively apply participant plan edits and select a new tier with an effective date to all participants of … Read More >>
Summit allows TPAs to designate Acceptable merchant locations, other than Transit or 90% Pharmacy, as “Acceptable Locations” by Merchant ID. The Debit Card authorization process may utilize a specific list of Merchant IDs categorized as Acceptable Locations to a specific Summit plan. The Acceptable Locations Merchant ID list may be used to authorize transactions from … Read More >>
While a single Third Party Payor (TPP) receipt can be applied to a participant’s billing, Summit is also able to apply a TPP receipt to multiple participants via Bulk Receipt Processing. Bulk receipt entry is available for the Third Party Payor functionality on the Employer Central Premium Billing Tab. This allows the user to add … Read More >>
Sum Multiple Tiers is a pricing method where the pricing of a benefit is determined by the selection of specific tiers assigned to a participant and dependents rather than a single tier encompassing the participants and their dependents. The Add Plan UI and Edit Plan UI include a Sum Multiple Tiers option. Users will be … Read More >>
Summit has the ability to communicate EOB information regarding the adjudication of claims in cases where a provider is the payee. If a provider bills the TPA, Summit may either generate communication to the provider in the form of a check/EOB or a note explaining why the plan did not reimburse the provider The Claim Adjudication Events sections of the TPA-level Plan … Read More >>
Summit allows TPAs to add providers and create provider networks that may be linked to particular benefit plans. These providers and provider networks are configured on the Advanced Plan Design | Provider Networks page. NOTE: For information on third party payees, see the Alternate Payees sections Add a Payee To Add a Payee: NOTE: The … Read More >>
One of the core functionalities of Summit is the creation and management of individual participant members of employer groups. This includes the entry of their basic demographic information, the entry and management of their dependent relations, the entry of participant banking information, and the assignment and management of benefits. These actions and more are handled … Read More >>
This is a tab that will be available to the DataPath, TPA, Broker, and Employer Users (with profile access) where they may enter notes that are specific to the Employee. The Notes feature is available as a sub tab to the Employee Central page. On this tab, a User may view or delete existing Notes … Read More >>
Participant Central is the page that collects and configures various Participant related information such as Demographics, Dependent, Banking, Plans, Cards, etc. Here the user can add or view and edit participant information. To access Participant Central, The Premium Billing Statuses dropdown will display when the employer is a Premium Billing Only or CDH + Premium … Read More >>
Summit allows the user to capture Participant specific banking and reimbursement-related details. Participant banking details can be viewed and recorded on the Banking tab of Participant Central. Banking details at the Participant level can be updated at any time. * Required fields appear in Red To add Bank Details Go to Participant Participant Central Click on … Read More >>
Users can view the premium billing details in Participant Central | Billing. This page displays all the coverage billing periods for the participant. Each billing period contains a summary row and coverage details rows for each summary row. Bills for all coverages with Plan Year Start Dates and Plan Year End Dates that are within … Read More >>
One of the ways in which Participants may access their health plan dollars is through a benefit-linked Debit Card. These debit cards allow Participants to go to the pharmacy or doctor and pay for the prescription or medical service provided. If the Participant is at an eligible type of merchant, the system will allow for … Read More >>
Participant Central page is where the creation and modification of participants can be done. The participant can be created either through a wizard or manually. Participant Demographics may be entered and reviewed on the Demographics subtab of the Participant Central page. * Required fields appear in Red To access Participant Demographics, Information about adding … Read More >>
Summit allows for information related to the Dependents of a Participant to be entered and retained for viewing and administrative purposes. Anyone the participant claims on their income tax return for a given tax year is considered as a dependent. * Required fields appear in Red To access the screen containing Dependent, Dependents associated with the participant … Read More >>
Summit will trigger Premium Billing events and notifications when an event occurs and benefit coverage options are changed. The events will generate based on the TPA/Employer-level settings configured in Premium Billing | Notifications & Communications | Event Settings. In the Participant Central | Events tab, the Coverage Line grid contains “Coverage”, “Type” and “Status” columns. … Read More >>
A Health Plan is a type of insurance that reimburses the cost of medical treatment when a participant is ill or injured. The Participants in Summit can be linked to the Health Plans via the Health Plans tab on Participant Central. Linking Participants The first field of the tab is the Health Plans dropdown list … Read More >>
Summit allows users to enroll Participants into the Plan offered by their Employer and to track the associated funding of those Plans (election amounts, etc.). The Plans tab allows users to view and manually assign the available plans to individual participants in Summit and perform Status Changes to premium billings coverages assigned to covered individuals. … Read More >>
Summit allows the user to select receipts to adjust, add, edit, or delete. These are the payments (receipts) received from the Participant for coverage premiums. The user is able to navigate to the Premium Payment pop-up from the participant’s Receipts tab using the Add Receipt button to enter a new receipt. * Required fields appear in … Read More >>
The Transactions tab of Participant Central shows recent transactions that have been applied to any of the Participant plans. It will show transactions of all types, including Manual Claims, Debit Card Claims, Repayments, Withdrawals, etc. Here, users can manually enter new transactions for the participant as well as view and edit existing transactions. * Required fields … Read More >>
One of the methods by which a user may enter and setup a new participant in Summit through Participant Central is by the Wizard. * Required fields appear in Red If the user selects Participant creation via the Wizard, they will be taken into the Participant Setup Wizard as shown below. In the header portion, the … Read More >>
The Participant Portal feature provides TPA users the ability to view and manage the user profile, coverages, cards, transactions, and investments (HSA) of the participants who all are registered in the Participant Portal from the perspective of a user accessing the Participant Portal. To access the Participant Portal, OR The “Login to Portal” link will … Read More >>
Summit offers investment-enabled Health Savings Accounts (HSAs) for individual participants. This feature allows participants to invest their HSA funds through Summit’s Investments platform available on the Participant Portal. Participants with investment-enabled HSAs will see an Investments menu option on the Participant Portal. The first time they click on Investments, they will be directed to the … Read More >>
TPAs can map a value from the Carrier Claim file comparable field to the Summit Service Category field available values. When a Service Category field is added to a template using the Carrier Claim (TPA) File Type, a Map link is available after the template is saved. Click the Map link to open a modal … Read More >>
Summit produces an array of PDF documents throughout the day, ranging from Reimbursements and remittances to Premium Billing event communications to receipt requests and so on. Summit gives TPA users a centralized view where they can review, pause, and remove Premium Billing Communications before they are processed. TPA users are able to view the documents, … Read More >>
Processing covers a wide range of activities within Summit. Most administrative tasks that are outside the scope of setting up entities and plan design falls within the umbrella of processing. Processing tasks include manual claim entry and processing, importing and exporting, handling enrollment, and much more. The Processing subpages may be accessed from the Processing … Read More >>
Cash Management is used to track balances and funds moving in and out of associated bank accounts in Summit. This module tracks deposits and debits from real bank accounts. In the Cash Management module, the TPA can: * Required fields appear in Red To access Cash Management, Cash Management Cash Management transactions can be searched using … Read More >>
The purpose of Data Exchange is to facilitate the secure exchange of data between Summit and third-party systems via the Integration Manager. It supports integration with payroll systems, online enrollment platforms, custodial systems, and more—using SFTP and/or manual file uploads and downloads through the Integration Manager user interface. TPAs and Partners can use flexible mapping … Read More >>
One of the features of Summit’s Data Exchange is the ability to export a wide array of data using user-defined templates and reports. To access Data Exchange | Exports, The Exports tab displays a grid of all exports you have configured. The grid includes: By default, inactive exports (those without the Active checkbox selected in … Read More >>
Summit’s Data Exchange feature allows for the import and export of a wide range of files and data, importing data into Summit and exporting Summit data in assorted output formats. The File History tab allows you to view and download files that have been processed through Data Exchange. If you have not configured an FTP … Read More >>
The configuration of your FTP information for Data Exchange is done on the FTP Details tab. Entities such as TPAs that wish to exchange data with Summit via SFTP will work with the DataPath Implementation team to configure the settings on this tab. You can choose whether you want to push information to Summit or … Read More >>
The Imports/Responses of the Data Exchange page allows you to schedule file imports and map each file to the applicable Summit File Type. For example, if the file to be imported is a participant/employee census file, you would select the Demographic File Type. You can then add any desired additional data elements (beyond the required ones) … Read More >>
While Summit allows for scheduling of import files through Data Exchange, there may be times when you need to run an import immediately. The Process On Demand tool enables you to upload and process an import file at any time. To access Process On Demand, Process On Demand From the Process On Demand interface, you can manually upload an … Read More >>
* Required fields appear in Red Summit offers extensive reporting capabilities as part of its data output functionality through Data Exchange. Unlike standard exports—which typically provide raw data for use in other systems, data validation, and similar tasks—reports are designed for human readability. They present the requested data in a structured, user-friendly format and can also be … Read More >>