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 >>
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 >>
Employer Central is where Employer related information, such as Demographics, Benefit Plans, Health Plans, etc., is entered, displayed, and may be viewed or modified in Summit. Here, users can add or view and edit employer information. * Required fields appear in Red To access Employer Central, Add Employer If the user wants to create a new … Read More >>
Coverage Levels/Tiers Tier Group – Available tier groups will be displayed for selection from this dropdown. This dropdown will pull Tier Groups and Tier Definitions from those configured in Advanced Plan Designs | Tier Groups/Definitions. By default “None Selected” will be selected. If a tier has been selected and information has been populated in 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 >>
The Premium Billing tab of Employer Central allows for the setup of premium billing information at the employer level, including the setup of banking information, subsidies, and Third-Party Payors. Here, the employer may be associated with an administrator-level template or assigned settings that may deviate from those templates and how those settings will apply for … 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 users to add CDH plans at the employer level. A consumer-driven health plan is a health insurance plan that allows employers, employees, or both to set aside pre-tax money to help pay for qualified medical expenses not covered by their health plan. CDHPs are linked to health savings accounts (HSAs) and integrated health … 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 >>
To access Plan Details/Add Rates UI: Each line on the list grid will have a Plan Year [CDH], Rates [Premium Billing], or Plan Year/Rates [CDH and Premium Billing] link. For CDH Employers Clicking the “Plan Year” link will open the Plan Details modal of the selected benefit plan. This page includes the following fields: Associated Plan Years In this section, the … Read More >>
Users are able to create Plan Year Defaults for Plan Years which may be associated with benefit plans set up at the Employer Level on the Benefit Plans Tab. * Required fields appear in Red When clicking the +Plan Year link on the Benefit Plans tab, you are able to create new Plan Year Defaults which … Read More >>
Summit Premium Billing is developed with the functionality of allowing participants to elect coverage for all benefit plan types. Summit can bill the participant, handle remittances, and generate events and notifications for the elected coverages, using the COBRA, Retiree, and Direct Bill. In order to add a Premium Billing plan to the participant, these plans … Read More >>
* Required fields appear in Red Add New Carrier The Add Carrier link on the Premium Billing tab of the Add Plan modal will open an Add Carrier popup modal that will allow you to configure settings for the carrier to be associated with the premium billing plan. Demographics Administration Contacts If the user wishes to … 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 >>
This is a subtab of the Employer Central page where the user may enter notes that are specific to the Employer. From this page, the user may view, edit, or delete an existing note or add a new note. Employer users will not have the ability to add, edit, or delete notes on this tab, … 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 >>
While Summit allows TPAs to create administrator-level default settings for how Summit debit cards behave in regards to Merchant Category Codes, Summit users may also configure settings at an employer-level from the Employer MCCs page. For more information about each of these tabs, click the linked heading. Plan MCCs The Plan MCCs tab allows users … Read More >>
In order to ensure cards are used for their intended purposes, the IRS mandates that cards be restricted to specific MCC Codes (Merchant Category Code). MCC Codes are the codes that Master Card assigns to merchants. It helps to identify the type of merchant in an authorization message. Summit has default MCC categories as well … Read More >>
To ensure the proper use of cards, the IRS mandates all cards to be restricted to some specific MCC Codes (Merchant Category Code). MCC Codes are the codes by which Master Cards assign to merchants. It helps to identify the type of merchant in an authorization message. The IRS also requires the review of every … Read More >>
In order to help ensure cards are used for their intended purposes, the IRS mandates that cards be restricted to specific MCC Codes (Merchant Category Code), the codes Master Card assigns to merchants to identify the type of merchant they are in an authorization message. Each employer plan will be accessible via a set of … Read More >>
Employer | Receipt Management | Settings Employer | Receipt Management | Request Employer | Receipt Management | Processing Receipt Management Receipts are documents used to verify the eligibility of expenses in a transaction. When a transaction cannot be auto-substantiated, the Summit will automatically generate letters/ emails to Participants requesting them to submit receipts or other documentations for expenses … Read More >>
Receipts are documents used to verify the eligibility of expenses in a transaction. When a transaction cannot be auto-substantiated, the system will automatically generate letters/emails to Participants requesting them to submit receipts or other documentation for expenses that cannot be auto-substantiated. Once this notice is sent, the Receipt Management process will be turned off for … Read More >>
Receipts are documents used to verify the eligibility of expenses in a transaction. When a transaction cannot be auto-substantiated, Summit will automatically generate letters/emails to Participants requesting them to send receipts or other documentation verifying the eligibility of the transaction. Once this notice is sent, the Receipt Management process will be turned off for that … Read More >>
Receipts are documents used to verify the eligibility of expenses in a transaction. When a transaction cannot be auto-substantiated, the system will automatically generate letters/emails based on these Receipt Management templates to Participants asking them to send receipts or other documentation verifying the eligibility of the transaction. Once this notice is sent, the Receipt Management … 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 >>
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 >>