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 for how Summit’s logic will handle run-out/timeout for claims, as well as whether the system generated claim numbers will appear on participant letters and display on the Participant Portal. Handling … 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 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 >>