Advanced Plan Designs allows you to configure a number of settings that have bearing on Administrator-level plan design defaults at a global level without necessarily having to put these settings in place while creating the plans themselves. The Advanced Plan Designs module of Summit includes set up sections for the following (for more in-depth information, … Read More >>
Carrier claim files for import and carrier EOBs that TPAs receive and use to enter claims in Summit often contain amount fields that do not correlate to what Summit uses for total Claim Amount, Ineligible Amount, and Approved Amount. To allow for TPAs to account for these discrepancies, users may define formulas for calculating the … Read More >>
Summit allows TPAs to configure providers and provider networks for reporting and reimbursement purposes for CDH plans. In the case of HRA plans, for instance, Employers and TPAs often limit the reimbursement of expenses to services provided by “In-network” providers or they may reimburse the expense at a reduced rate for a service performed “out-of-network”. … 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 >>
Service Codes correspond to different types of treatments or services a Participant may receive from a provider. These codes are utilized during claims processing to determine reimbursement eligibility and copays based on plan designs and the service code attributes. When Service Codes are entered for a claim, it identifies the type of treatment that was … Read More >>
* Required fields appear in Red Many plans, particularly HRAs, have different levels of coverage and other limits. One of the mechanisms of designing such plans and benefits is the use of funding tiers. Funding Tiers may be custom built by administrators based upon specific plan designs. These tiers may be created at the TPA level … Read More >>