Inpatient support

Instructions for requesting prior authorization when you patient has been or needs to be admitted to a facility

Urgent/Emergent Hospital Admissions

Notify Summit Health within 48 hours of all urgent/emergent admission.
Fax number: 855-637-2666.

Skilled Nursing Facility Admissions

Call or fax notification for skilled nursing facility admissions to Healthcare
Services; call us at 844-931-1778 or fax at 855-637-2666.

Elective inpatient procedures

1. Prior authorization is required for all inpatient admissions. Failure to obtain authorization may result in non-payment of claim and provider liability. Members may not be balance billed.
2. Before requesting authorization, verify member's eligibility and benefits through online access in EBT.
3. Verify that the requested provider or facility is in-network via our provider search tool.
4. Summit Health Medical Necessity Criteria, MCG guidelines, or CMS guidelines may be used for coverage determination.
5. Verify member network availability and any contract specific prior authorization requirements through EBT.
6. Prior authorization of a service or procedure does not guarantee payment.