SummaCare (Apex) Provider Resources

SummaCare has partnered with EviCore to provide patients with access to high-quality, medically appropriate care that is consistent with evidence-based treatment guidelines.  As part of these efforts, the programs listed below will require prior authorization for patients covered by SummaCare effective the following dates:

• Cardiac Implantable Devices & Vascular Intervention – Begin submitting prior authorization requests 11/24/2025 for dates of service 12/01/2025 and after.

• Musculoskeletal Pain Management, Joint & Spine Surgeries – Begin submitting prior authorization requests 12/15/2025 for dates of service 01/01/2026 and after.

   

For a list of the CPT codes being managed by EviCore, please visit the Solutions Resources section of the SummaCare resource site by clicking HERE.

EviCore by Evernorth is pleased to announce its partnership with SummaCare to provide authorization services for SummaCare members enrolled in Medicare and Commercial plans for dates of service beginning July 1, 2020. Prior authorization will be required for selected Radiation Oncology, Medical Oncology, and Laboratory services.