MSP Reporting is automated based on the Submission Period selected by the TPA on the TPA Demographics tab. The file is being generated and uploaded to CMS via SFTP on or before the last day of the Submission Period. Summit retrieves the response file and import the contents. MSP Reporting RRE ID and MSP Reporting … 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 >>
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 >>
There are certain cases where a subsidy may apply to a participant’s billing. These subsidies can reduce or even eliminate a participant’s premium responsibility, fee amount responsibility, or even both. These subsidies are assigned to the participant’s premium billing coverages, and Summit will automatically adjust the participant’s past, current, and/or future billing according to the … 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 >>
* Required fields appear in Red The user may add a new Division for an employer during participant setup from the Participant Central | Demographics tab by clicking the “+Add New Division” link. Clicking the link will open a Division modal where the user may enter the new division information. Division Name – Here the user must enter … Read More >>
* Required fields appear in Red The user may add a new location for an employer during participant setup from the Participant Central | Demographics tab by clicking the “+Add New Location” link. Clicking the link will open a Location modal where the user may enter the new location information. Location Name – The user has … Read More >>
* Required fields appear in Red The user may add a new Union for an employer during participant setup from the Participant Central | Demographics tab by clicking the “+Add New Union” link. Clicking the link will open a Union modal where the user may enter the new union information. Union Name – The user must enter a … 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 >>
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 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 >>
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, Pass Phrase, Password, Security Questions, … 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 >>
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 >>