Verify SummaCare Health Plan eligibility in real time.
SummaCare Health Plan supports electronic real-time eligibility. Send the check to payer ID 95202 and the full benefits picture comes back in under a second, before the patient sits down.
Under 1 second
The same SummaCare Health Plan check that takes 15 to 25 minutes on the phone. Ten patients tomorrow: ten checks, or three hours on hold.
1 billing name
Every one routes to payer ID 95202, and so do 5 older payer IDs still printed on cards. No guessing which card this is.
2 programs
SummaCare Health Plan runs Commercial and Medicare plans in Ohio. One setup, every patient on the schedule verified before they arrive.
First month free
Then $2.50 a check, only when you run one. No seat fees, no platform fee, no contract. Cancel any time.
The phone way
Call, hold, transcribe, repeat.
Verifying SummaCare Health Plan by phone means a menu, a hold queue, and 15 to 25 minutes per patient while someone at the desk reads benefits back by hand. Ten patients on tomorrow's schedule is half a workday on hold.
The real-time way
Payer ID 95202, under a second.
The same check, sent electronically. Valian runs it automatically for every patient on the schedule before the day starts, and flags the ones that need a human look.
| By phone | In Valian | |
|---|---|---|
| Time per patient | 15 to 25 minutes on hold | Under a second |
| When it happens | Day of, squeezed between patients | Before the day starts, automatically |
| What you get | Notes scribbled while someone reads benefits aloud | The full breakdown, saved to the patient |
What a SummaCare Health Plan eligibility check returns
- Whether coverage is active, with plan and group details
- Deductible, and how much of it is already met this year
- Annual maximum, and how much of it is left to work with
- Coverage percentages by category: preventive, basic, major
- Frequency limits on cleanings, exams, and X-rays
- Waiting periods, where SummaCare Health Plan reports them electronically
Eligibility result
Sample data- Status
- Active
- Plan
- PPO · Group 8823
- Deductible
- $50 · $0 met
- Annual max
- $1,500 remaining
- Preventive
- 100%
- Basic
- 80%
- Major
- 50%
- Cleanings
- 2 / year
Returned in under a second · payer ID 95202
How practices handle this today, in their own words
Verbatim from recorded calls to dental offices. Names withheld.
We call the insurance, or I go on their website and do it. Yeah, we manually do it.
We have a third party insurance verification team that does it for us. I’m not too sure, maybe like seven, ten minutes.
Our system does it, and the ones that are not set up for electronic, we do ourselves.
How getting set up works
Sign up
About ten minutes: create the account, sign the agreement, and your free first month starts.
Connect your system
We connect your practice management software with your office manager. Open Dental, Dentrix, Eaglesoft, and more.
Checks run themselves
Every patient on the schedule gets verified automatically before their visit, SummaCare Health Plan included. Your team just reads the results.
Under half an hour of your time all in. See the full walkthrough on the insurance verification page.
What SummaCare supports electronically
- Real-time eligibility (270/271)
- Yes, under a second
- Enrollment for eligibility
- None, checks work day one
- Dental claims (837D)
- Not offered electronically
- Claim status (276/277)
- Yes
- Electronic remittance (835)
- Yes, after a one-click enrollment, typically a few days
- Electronic funds transfer
- Not offered electronically
- Claim attachments
- Not offered electronically
Names and IDs this payer goes by
SummaCare Health Plan. Older cards may show payer ID 10294, 1755, 589, 95202MA and SUMCHP. All of them route to payer ID 95202.
Payer site: www.summacare.com
How to verify SummaCare Health Plan, step by step
Get the member ID and date of birth from the card or the patient.
Send the electronic eligibility request (a 270) to payer ID 95202.
Read the response (the 271): status, deductible, max, percentages, frequencies.
Save the breakdown to the patient. Valian does all four automatically, before every visit.
SummaCare Health Plan runs Commercial and Medicare plans across Ohio. Medicare dental benefits live in the specific Advantage plan, not in Medicare itself, so the plan on the card decides.
SummaCare Health Plan, quick answers
Does SummaCare Health Plan support real-time eligibility?
Yes. Eligibility checks to SummaCare Health Plan clear electronically in under a second through payer ID 95202.
What payer ID do I use for SummaCare Health Plan?
95202 for eligibility transactions.
What does a check cost with Valian?
$2.50 per verification, run automatically before every appointment. Your first month is free, with no contract and no seat fees.
Does SummaCare Health Plan require enrollment before I can check eligibility?
No. Eligibility checks work from day one, with no payer enrollment paperwork.
Which SummaCare Health Plan plans does this cover?
SummaCare Health Plan runs Commercial and Medicare plans in Ohio. The eligibility check reads the specific plan on the patient's card, whichever program it belongs to.
Can I get SummaCare Health Plan remittances electronically?
Yes. SummaCare Health Plan sends electronic remittance advice (835) after a one-click enrollment, typically a few days.
What if the patient's card shows a different SummaCare name?
Alternate billing names route to the same payer ID, 95202. The check resolves them automatically.
More questions about verifying SummaCare Health Plan? Schedule 15 minutes with us and bring your toughest plan.
Every SummaCare Health Plan patient, verified before they walk in.
First month free, then $2.50 a check. No seat fees, no platform fee, no contract.
Book 15 minutes, demo or onboarding
Pick a time, then tell us on the form whether it is a demo or an onboarding call.
Related payers
- Verify Aetna Better Health Ohio eligibility
- Verify AmeriHealth Caritas Ohio eligibility
- Verify Anthem Blue Cross and Blue Shield MyCare Ohio eligibility
- Verify Anthem Blue Cross Blue Shield (Ohio Medicaid) eligibility
- Verify Anthem Blue Cross Blue Shield Ohio eligibility
- Verify Anthem Blue Cross Blue Shield Ohio - Dental eligibility
Payer names and marks belong to their owners and identify the insurance company a practice can verify. Sample result shown for illustration; real results reflect the patient's actual plan. Payer capabilities can change between network updates.