Summit User’s Guide by Category (based on the menu structure within Summit)
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 >>
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 >>
* Required fields appear in Red Summit allows the user to elect coverages for Participants. The system will allow the user to select or deselect Dependent(s) in the Election Coverage section. If the user wants to elect coverage for the participant, then follow the steps described in the Participant | Participant Central | Plans, and open … Read More >>
Qualifying events are certain events that result in the right to continue benefit coverage under COBRA. An employee, spouse, and/or dependent child who loses coverage as a result of a qualifying event becomes a Qualified Beneficiary. Employment Termination, Reduction of Hours, Retirement, etc. are some examples of Qualifying Events. To access Dependent Qualifying Events, follow the … Read More >>
The user are able to perform rate changes for participant’s premium billing plans when the beginning coverage status is “Active” or “COBRA”. * Required fields appear in Red To access Rate Change, Rate Change in Active Coverage Status When the edit icon is clicked, the Coverage Detail modal of the selected PB Plan will appear as … Read More >>
Qualifying events are certain events that result in the right to continue benefit coverage under COBRA. An employee, spouse, and/or dependent child who loses coverage as a result of a qualifying event becomes a Qualified Beneficiary. Employment Termination, Reduction of Hours, Retirement, etc. are some examples of Qualifying Events. To access Policy Holder Qualifying Events, follow … Read More >>
Qualifying events are certain events that result in the right to continue benefit coverage under COBRA. An employee, spouse, and/or dependent child who loses coverage as a result of a qualifying event becomes a Qualified Beneficiary. Employment Termination, Reduction of Hours, Retirement, etc. are some examples of Qualifying Events. To access Qualifying Events, Go to Participant. … 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 >>
The Summit has been designed to produce reimbursements to participants for the claims they have submitted to the TPA. TPAs can enter claims submitted by participants and specify a reimbursement method for those claims and create reimbursement checks/ACH files. The On Demand Reimbursements tool on the Participant Central | Transactions tab allows TPA users to … Read More >>
Users are able to search for claims and other transactions associated with an individual participant (and his or her dependents) by clicking the View Transaction History link at the top of the Participant Central Transactions tab. Clicking this link will produce a pop-up window in which the user can search for transactions associated with that … 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 is a means by which participants can access, view, and manage their user profile, coverages, cards, transactions and benefit and investment accounts in Summit. Once they have been added to Summit and have a valid email address, a welcome notice will be sent with instructions on how to register for the portal, … Read More >>
Debit Cards are a way of providing electronic access to plan funds. TPAs issue debit cards to participants that are linked to their benefit plans. These debit cards allow participants to go to the pharmacy or doctor and pay for the prescription or medical service provided. directly with plan dollars. If the participant is at … Read More >>
The coverages page will display all of the active plan years in which a participant is currently enrolled. If the participant was enrolled in a plan year and all of the associated dates are in the past, the plan year details will not appear on the page. The plan year will be listed on the … Read More >>
The purpose of the Participant Portal is to provide participants the ability to view their balances, view manual claims or card transactions that have processed against their elected plans, enter manual claims, and upload associated receipts to be reviewed and approved by the TPA. To access Home, Based on the employer’s benefit administration type: CDH-only, … Read More >>
The Investments pages of the Participant Portal allow account owners of investment-enabled accounts to make investments, view their portfolio, trade shares of funds, liquidate shares, research funds and view relevant documents. Instructions for first-time investors can be found here. View Portfolio The View Portfolio screen displays the participant’s balances and the breakdown within their portfolio, … Read More >>
Participants can view their account information in Participant Portal by clicking the User ID or user image displayed at the top of the Participant Portal page. * Required fields appear in Red To access Profile, Participant Profile From the Participant Profile page, the user can update the Participant’s Name, Contact Details, Password, Security Questions, Address, Dependents … Read More >>
The Participant Portal allows the Participant User to access, view, and enter different transactions. There are four subsections of the Transactions menu in the Participant Portal that may be accessed from the dropdown menu. These are Transaction History, Claims Vault, Transactions and Add a Transaction. Transaction History The Transaction History page will display by default … Read More >>
The Add A Transaction menu will take the user directly to the Add A Transaction interface with no need to first access either Transactions or Claims Vault and click the Add Transactions button. For information on entering transactions, see the links below for the specific transaction type. If you are looking for further information, please … Read More >>
To add an Online Claim on the Participant Portal, OR Upload Receipt/EOB – From here, the participant can upload an image of the receipt or EOB associated with the claim to provide documentation showing that the expense was eligible for reimbursement. The participant can upload a file of 100 MB or less and of the … Read More >>
The “Withdrawal” transaction allows a participant to withdraw the amount from the benefit plan and reduces the balance of the participant through a check or direct deposit (ACH) to the participant. OR
Summit allows participants to make Deposits to individually owned accounts, such as HSAs, via the Participant Portal. OR
The Repay Balance Due option allows a participant to return funds to their benefit account for denied or ineligible transactions. OR The system will display a grid of the outstanding balance due transactions. This grid is based on the Ineligible or Expense Denied entries in the Transactions Requiring Attention list and displays the following details: … Read More >>
Update a Card Claim page allows participant users to manually update an outstanding card transaction from the Participant Portal. This will allow them to provide substantiation for outstanding claims through the portal rather than submit a new claim, as well as modify some of the details of the card transaction. * Required fields appear in Red … Read More >>
Summit allows participants to make premium payments via the Participant Portal. Here, the variable ACH fee amount ($2.00 to $100.00 per transaction) designated by the TPA in the Participant Portal Settings UI will display as Service Fee when the participant is the ACH fee payor. Press the Submit button to save the payment details. Once … Read More >>
Users can enter an expense (like a claim) or upload the associated receipt or EOB and store it in the system via the Claims Vault. Claims submitted to the Claims Vault can be reimbursed at any later time and will not be visible to the TPA in the main application. * Required fields appear in Red … Read More >>
The Transaction History page displays a participant’s transaction history across all plans, allows the user to search for specific transactions or those meeting certain criteria, and performs specified actions from the user. To access Transaction History, The Transaction History page is divided into subsections that are differentiated between CDH and PB transactions based on the … Read More >>
Users can initiate transactions like Online claims, withdrawals, Repayment of the balance due, pay a premium, and Vault Claims via the Participant Portal. * Required fields appear in Red Online Transactions The Online Transactions section will display for all participants, but the verbiage displayed will depend on the participant’s plan type : From this screen, the … Read More >>
Participants are able to set up recurring payments on the Transactions subscreen of the Participant Portal. Recurring Payments This link will open the Add/Edit Recurring Payments UI which allows participants to set up a recurring payment schedule for Premium Billing benefit premiums. Participants with banking information in Summit will be able to configure recurring auto-draft … Read More >>
Summit allows users to add CDH plans to eligible participants. Participants can be enrolled in as many Plans as they are eligible for. The system will validate whether a Participant is eligible for enrollment in a plan by analyzing the Participant’s demographics and comparing them to the eligibility requirements of each Employer Plan. If the … Read More >>
This page outlines the best practices for: ACH and Credit/Debit Card Management and Remittance The flexibility of Summit Premium Billing allows participants to make ACH and credit/debit cards via the Participant Portal and mobile app. The following are suggested best practices for managing ACH and card payment remittances and communications. Remit to Entity – Remit … Read More >>
Plan Default Settings allow for the creation of plan templates, reimbursement schedules, contribution schedules, and benefit orders at a global level. These settings may also be applied at the employer level in ways that deviate from the TPA default settings. To access Plan Default Settings: There are five screens to the Plan Default Settings module. … Read More >>
Participants enrolled in benefit plans may have access to multiple purses with their plan dollars. Different benefit plans cover and pay out different amounts for different products/service based on the plan design. Because Summit allows for many different kinds of plans to be designed and assigned to participants and for those purse values to be … Read More >>
Schedules are pre-defined processes that are used to generate or post Contributions in batches. Contribution Schedules are used to pull contributions for contribution-funded benefits. Summit will automatically calculate contributions from both employers and participants to plans based on Contribution Schedules. The TPA user can add, edit, and view schedules from the Contribution Schedule option in … Read More >>
* Required fields appear in Red The Denial Codes/Comments section of Plan Default Settings allows you to view and modify the Denial and Request codes for claims submitted for reimbursement through Summit. [Not to be confused with Premium Billing Denial Codes which are used for when an individual is denied coverage.] When reviewing participants’ claims, if … Read More >>
DirectPay is a feature by which we are able to securely integrate payment information so that participants can use their plan dollars to shop at FSAStore.com, an online health products retailer. DirectPay allows Summit Participants to utilize their FSA dollars to make direct purchases of goods and automatically create claims in Summit for the corresponding … Read More >>
The Plan Templates screen allows you to set up global benefit templates. Templates for FSAs, Dependent Card, HRAs, Parking and Transit, HSAs, etc. can be configured here at a TPA level and later assigned to employers. * Required fields appear in Red To access Plan Default Settings | Plan Templates, Plan Templates The Plan Templates section … Read More >>
* Required fields appear in Red TPAs may add or modify Default Plan Years from the Plan Settings | Plan Templates Page. This page includes definitions for the various settings available on the Default Plan Years modal. By Clicking on the “Add New” button, a page will display as shown below with the following fields. This … Read More >>
* Required fields appear in Red TPAs may add or modify Plan Templates from the Plan Default Settings | PlanTemplates page. This page includes a breakdown of which settings and defaults will display for the various plan types as well as the definitions for the various settings available on the Plan Templates modal. Plan Template – … Read More >>
The Plan Default Settings | Reimbursement Settings page is where you will customize the TPA-level business logic by which Summit will process claims and generate reimbursements for participants. To access Plan Default Settings | Reimbursement Settings: General Settings This tab contains run-out/timeout logic settings as well as an option for whether Summit should include the … Read More >>
Summit moves money from designated accounts to create and issue checks as well as ACH payments for participant and provider reimbursement. The banking information necessary to facilitate this money movement for reimbursement may be configured on the Banking/Checking tab of Plan Default Settings | Reimbursement Settings. * Required fields appear in Red To access Plan Default … Read More >>
Summit’s Claims Entry Preferences option allows the user to add fields from a list of Summit-defined optional fields to the claim form, rearrange the position of distinct claim entry fields to better suit the needs of particular groups or plans. To access Claims Entry Preferences, Go to Settings. Click Plan Default Settings. Select Reimbursement Settings. … 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 Reimbursement Settings Communications tab is to configure default values at the TPA level that will drive the reimbursement communication process. The Communications tab contains the settings for how Summit … Read More >>
There are several ways in which claims may be entered in Summit—manually by TPA, by participant entry through 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 weed … Read More >>
* Required fields appear in Red When accessing Plan Default Settings | Reimbursement Settings, the General Settings Tab will display by default. This tab contains settings that determine how Summit handles claim run‑out or timeout logic, as well as whether system‑generated claim numbers display on participant letters and in the Participant Portal. Handling claims past the … Read More >>
Reimbursement creation in Summit is a batch process that, like many other processes in Summit, is driven by Schedules. Reimbursement schedules in Summit can be set up and configured at the TPA level from the Schedules tab within Plan Default Settings | Reimbursement Settings. * Required fields appear in Red To access Plan Default Settings | … Read More >>
Summit Premium Billing was developed to allow participants to elect coverage for all benefit plan types. Summit can bill participants, perform remittances, and generate events and notifications for elected coverages using the COBRA, Retiree, and Direct Bill interfaces. Users can edit Premium Billing settings from the Settings menu. To access Premium Billing settings: Premium Billing … Read More >>
The Denial Codes & Comments section of Premium Billing allows users to add, view, and edit denial codes used when an individual is denied coverage. * Required fields appear in Red To access Denial Codes & Comments: Denial Codes In this section, users can add, edit, and delete denial codes. The Codes table (Fig. 3) lists … Read More >>
Summit allows users to customize and create notifications (letters and emails) to meet both TPA and Employer communication needs. This section covers Summit’s Premium Billing communication features, which support sending letters and email notifications between the TPA, Employers, Carriers, and Participants. To access Premium Billing Notifications & Communications: The Notifications & Communications page will display … Read More >>