HEDIS (Healthcare Effectiveness Data and Information Set) HEDIS is a set of standardized performance measures developed by the National Committee for Quality Assurance (NCQA) which allows comparison across health plans. Through HEDIS, NCQA holds SilverSummit Healthplan accountable for the timeliness and quality of healthcare …Policies in the SilverSummit Healthplan Payment Policy Manual may have either a SilverSummit Healthplan or a “Centene” heading. In addition, SilverSummit Healthplan may from time to time employ a vendor that applies payment policies to specific services; in such circumstances, the vendor’s guidelines may also be used to determine whether a …SilverSummit Healthplan P.O. Box 5090 Farmington, MO 63640-5090 SilverSummit Healthplan will make reasonable efforts to resolve this request within 30 calendar days of receipt. Based upon the information submitted, we will either uphold our original decision (if we uphold our original decision, we willMusculoskeletal Services Procedures need to be verified by TurningPoint . Medical Oncology, Hematology, Urology, Surgical Oncology, Neurological Oncology, Gynecologic Oncology, and Radiation Oncology will submit their chemotherapy prior authorizations through New Century Health (Effective 11/1/23). Non-participating …Ambetter from SilverSummit Healthplan is underwritten by SilverSummit Healthplan, Inc., which is a Qualified Health Plan issuer in the Health Insurance Marketplace.Jun 20, 2018 ... I believe the 3 options are Anthem Blue Cross, Health Plan of Nevada, and SilverSummit. ... They gave me SilverSummit but if everyone says anthem ...SilverSummit Healthplan Payor ID is 68069. Our Clearinghouse vendors include Availity, Change Healthcare (formerly Emdeon) and McKesson. For questions or more information on electronic filing please contact: SilverSummit Healthplan. c/o Centene EDI Department. 1-800-225-2573, extension 6075525. Or by e-mail at [email protected]’s designed to provide you with valuable education and materials to simplify your administrative responsibilities—so you can focus on providing care. Ambetter from SilverSummit HealthPlan offers a toolkit of provider resources so you can focus on providing care. Learn more about our health insurance provider support.SilverSummit Healthplan Member Services Department at 1-844-366-2880 or mail it to SilverSummit Healthplan Member want to make this request over the phone, please call the SilverSummit Healthplan Member Services Department, from 8 a.m. to 5 p.m. (PST), Monday through Friday, at 1-844-366-2880 (TDD/TTY 1-844-804-6086).SilverSummit Healthplan is committed to establishing multicultural principles and practices throughout its organizational systems of services and programs. That mission is supported by facilitating the process by which SilverSummit Healthplan can respond to the health care needs of all individuals, regardless of their ethnic, …Contact us at 1-866-263-8134 and we will work with you (and, if you wish, with your doctor) to find a wellness program with the same reward that is right for you in light of your health status. You will only be able to purchase public transportation directly from the agency either in-person or online. Passes can not be purchased through retail ...And if you have a severe medical condition, our Care Managers will work with you, your PCP and managing providers to develop a plan of care that meets your needs and your caregiver’s needs. Call us at 1-866-263-8134 ( TTY 1-855-868-4945 ). If you have a complex medical or behavioral health need, Ambetter from SilverSummit …The Summit Center is located at 323 N. Maryland Parkway, on the WestCare Community Triage Center campus. The facility is open from 8 a.m. to 4:30 p.m., seven ...SilverSummit Health Plan. Website: https://www.silversummithealthplan.com/members/medicaid.html. Telephone: (844) 366-2880. Medical services covered. For a full ...Welcome to the Start Smart for Your Baby program. We created this program to provide advice and resources for pregnant members and new parents. Whether this is your first child or you already have children, extra support is always helpful. Here you’ll find tips and resources to help you, your new baby, and your family get off to …Part C (and Part B Drugs) Appeal: Wellcare By Allwell. Part C Appeals. Medicare Operations. 7700 Forsyth Blvd. Saint Louis, MO 63105. Fax: 1-844-273-2671.SilverSummit Healthplan will conduct random medical record audits as part of its QI program to monitor compliance with the medical record documentation standards. The coordination of care and services provided to members, including over/under utilization of specialists, as well as the outcome of such services also may be assessed during a …Centene may at any time modify these terms and conditions and your continued use of this site will be conditioned upon the terms and conditions in force at the time of your use. 12. Additional Terms. Additional terms and conditions may apply to purchases of goods and services and other uses of portions of the Site, and you agree to abide by ... You can also reach us from 8am-8pm PST at 1-866-263-8134 ( TTY 1-855-868-4945 ). There are many ways to get in touch with us, and resources available on our website: Existing Ambetter Members – Change your Primary Care Provider (PCP) or see your benefits. The form fields are loading, please wait. May 9, 2019 ... http://lasvegasheals.org SilverSummit Healthplan Innovations for Nevada Medicaid - IM #043 Doug is joined by SilverSummit Healthplan Interim ...We would like to show you a description here but the site won’t allow us.Use your 1095-A to file Form 8962 with your tax return. These two forms will determine the amount of your tax credit. If you file a paper return, you can get Form 8962 here. Using these two forms to file your taxes correctly and on time is very important! If you don't, you may lose your tax credit, resulting in higher premiums … AcariaHealth’s licensed pharmacists are also available to you 24/7 to discuss prescribed therapy and answer any questions regarding medications and supplies. AcariaHealth will work with your current specialty pharmacy provider to seamlessly transition your medications safely and efficiently. To get started, contact us at 1-800-511-5144. Silver Summit Health Plan Dental. Silver Summit Health Plan Dental Best SilverSummit Healthplan Podiatrists Near Me. a Silver Summit Health Silver Summit ...View our 2023 Ambetter Plan Brochure to see the valuable benefits each plan has to offer. 2023 Ambetter Bronze, Silver, and Gold Plan Brochure (PDF) 2023 Ambetter Value Plan Brochure (PDF) Plans may vary by county. Please enter your zip code to see plans available in your area. Health Savings Accounts (HSAs) are available with certain …A rising suburb of Kansas City with just under 100,000 people, Lee’s Summit has attracted new residents over the past decade with its low crime,… By clicking "TRY IT", I agr... Interested in joining our network as a SilverSummit Healthplan provider to help Nevada Medicaid members? Contact us and get started today. ... Choose SilverSummit ... Whether you are an automotive enthusiast or a professional mechanic, finding the right parts for your vehicle is crucial. When it comes to performance upgrades and modifications, S...SilverSummit Healthplan gets you access to a large network of doctors and specialists in Nevada. So you can get the care you need close to home. Our local staff can help you make the most of your Medicaid coverage. Call Now 1-844-366-2880Jan 19, 2018 ... https://LasVegasHEALS.org http://VegasVideoNetwork.com Managed Care Organization SilverSummit Healthplan and its Nevada Launch - Inside ... We have local staff from communities where you live to help you access food, housing, transportation and more. If you have questions, contact us at [email protected] or call us at 1-844-366-2880 (TTY/TDD: 1-844-804-6086). No referrals needed to see. in-network specialists. Access to same-day mental heath appointments. Dec 1, 2021 ... Nevada Members transitioning from Managed Care Plans: Anthem BCBS, Health. Plan of Nevada and Silver Summit Health Plan. As we prepare to go ...Whether you are an automotive enthusiast or a professional mechanic, finding the right parts for your vehicle is crucial. When it comes to performance upgrades and modifications, S...Scan code to learn more about all of these free extra benefits and our Dollar Rewards Program or call Member Services at 1-844-366-2880. Mental Health Services. Same Day Access and immediate access to crisis and triage services. Housing assistance Chemical dependency assessments.SilverSummit Healthplan empowers its members to be active participants in their health and wellbeing which supports their mission of improving the quality of ... SilverSummit provides a broad network of behavioral health providers in Washoe and Clark counties. We also partner with Summit Behavioral Health Services to guarantee access to appointments. Please contact Summit Behavioral Health Services at 702-935-8700 for assistance in getting an appointment. You can also call 1-844-366-2880 and select the ... Glassdoor gives you an inside look at what it's like to work at SilverSummit Healthplan, including salaries, reviews, office photos, and more. This is the SilverSummit Healthplan company profile. All content is posted anonymously by employees working at SilverSummit Healthplan. See what employees say it's like to work at SilverSummit Healthplan.Healthy partnerships are our specialty. With Ambetter, you can rely on the services and support that you need to deliver the best quality of patient care. You’re dedicated to your patients, so we’re dedicated to you. When you partner with us, you benefit from years of valuable healthcare industry experience and knowledge.If you want to know if a service needs authorization, you can call Member Services. The phone number is 1-844-366-2880, TTY: 1-844-804-6086, Relay 711. There is more information about this later in the handbook. See the …Wellcare By Allwell Appeals & Grievances Medicare Operations 7700 Forsyth Boulevard St. Louis, MO 63105. Fax: 1-844-273-2671. Part D Appeals: Wellcare By Allwell Medicare Part D Appeals P.O. Box 31383 Tampa, FL 33631-3383.Activate Your Ambetter Health Online Account. Stay connected to your Ambetter health insurance through your online member account. It’s always available, 24/7 on your computer or smartphone. It’s your one-stop-shop for managing your Ambetter health insurance plan. Access Ambetter Virtual 24/7 Care* to set up convenient …Authorized Agent for Silver Summit Health Plans 600×200. Individual and Family Health Insurance in Las Vegas, Nevada. Share this post ...AcariaHealth’s licensed pharmacists are also available to you 24/7 to discuss prescribed therapy and answer any questions regarding medications and supplies. AcariaHealth will work with your current specialty pharmacy provider to seamlessly transition your medications safely and efficiently. To get started, contact us at 1-800-511-5144.Wellcare By Allwell from Silver Summit Health 7700 Forsyth Boulevard Clayton, MO 63105. 1-800-977-7522 (TTY: 711) 1-844-796-6811 (TTY: 711)24/7 Nurse Advice Line. Talk to a registered nurse any time of the day or night with this free service. The 24/7 Nurse Advice Line provides quick, reliable advice for medical situations that aren’t life-threatening. Call the Nurse Advice Line any time at 1-866-263-8134 ( TTY 1-855-868-4945 ). Call the 24/7 Nurse Advice Line if you …Allwell from SilverSummit Healthplan. Address: 2500 N. Buffalo Drive, Suite 250 Las Vegas, NV 89128 Website: allwell.silversummithealthplan.com Provider Services . Phone: 1-833-854-4766 (TTY: 711) Member Services Phone: 1-833-854-4766 (TTY: 711) From . October 1 – March 31, you can call us 7LAS VEGAS, Nov. 4, 2020 /PRNewswire/ -- Beginning November 1, 2020 through January 15, 2021, Nevada residents may select Ambetter from SilverSummit Healthplan for healthcare coverage statewide ...When SilverSummit members go to the doctor and do other healthy activities, they earn reward dollars they can spend at Walmart on groceries, clothing, electronics, school supplies, appliances, sports equipment, and other things they need. * Become a member today and start earning rewards while managing your health. If you have any questions or need more information on anything, please call us 8 a.m.-5 p.m. We are here for you. 1-844-366-2880 (TTY/TDD 1-844-804-6086) SilverSummit Healthplan welcomes all members and is dedicated to giving you quality care. Learn more about Nevada Medicaid today. On December 9, 2022, SilverSummit Healthplan sent a postcard announcing certain 2023 Enhanced Over-the-Counter (OTC) benefits. Unfortunately, there was a typo in the Member Services phone number listed at the bottom of the postcard. If you have questions regarding your SilverSummit Healthplan benefits, please call (844) 366-2880, TTY (844) 804 ...Visit the ER. If it’s an emergency, call 911. Only visit the emergency room if you have a life-threatening, serious injury, like bleeding or broken bones. Choose other care options if your injury is minor to maximize your benefits and lower your costs. View the article for more tips on care options you can choose. Please use the Grievance, Appeal or Concern Form or call Member Services at 1-844-366-2880 or TTY/TDD 1-844-804-6086. If you have been denied a service that you feel you should receive. please notify us as soon as possible. SilverSummit Healthplan hopes you're always happy with our services and providers of Medicaid in Nevada. Nov 1, 2023 · Behavioral Health services are handled by Silver Summit Health Plan. Musculoskeletal Surgical Services need to be verified by TurningPoint. Effective for dates of service 05/01/2024 forward, Cardiac Surgical Services also need to be verified by TurningPoint. The following services (identifiable by procedure code search) need to be verified by ... Phone Numbers for SilverSummit Healthplan Member Services The phone and fax lines listed in the Prior Authorization Process section are dedicated to clinicians requesting PA medication items only. Members cannot be assisted if they call the PA toll-free number. SilverSummit Member Services may be reached at 1-844-366-2880 (TTY 1-844-804 …Get the answers you need. Using your Ambetter online member account puts you in control of your health coverage. Ambetter from SilverSummit HealthPlan provides details on testing costs, coverage & treatment for the coronavirus. Learn more Ambetter coronavirus information. What you need to know: Check Your Application Status! If you have Medicaid coverage, don’t risk losing your Medicare Advantage Dual Special Needs Plan (D-SNP) and Medicaid benefits. Welcome to Wellcare By Allwell's new Medicare Advantage website. We are simplifying Medicare so you can choose and use an affordable local plan that will help you ... When you begin shopping for a Marketplace health plan, you’ll see plan options with different metal tiers such as Gold, Silver and Bronze plans. But the only difference between these plans is how much premium you’ll pay each month and how much you’ll pay for certain medical services. A Bronze plan typically gives you lower monthly premium ... If you want to know if a service needs authorization, you can call Member Services. The phone number is 1-844-366-2880, TTY: 1-844-804-6086, Relay 711. There is more information about this later in the handbook. See the …Nevada Silver Summit. Updated March 1, 2024. 1. Page 10. Drug Name. Drug. Tier. Requirements/. Limits methylphenidate hcl. TBCR 10 MG, 36 MG. F. QL(2 ea daily);. Healthy partnerships are our specialty. With Ambetter, you can rely on the services and support that you need to deliver the best quality of patient care. You’re dedicated to your patients, so we’re dedicated to you. When you partner with us, you benefit from years of valuable healthcare industry experience and knowledge. SilverSummit’s active community evolvement reaches beyond physical and mental health. The plan is dedicated to improving the quality of life, one person at a time. SilverSummit Healthplan is a diversified healthcare organization that offers healthcare services through Nevada Medicaid, Medicare, and the Health Insurance Marketplace.Welcome to Ambetter from SilverSummit Healthplan Nevada (“Ambetter”). Thank you for participating in our network of high quality physicians, hospitals, and other healthcare professionals. Ambetter’s Health Insurance Marketplace plans target a consumer population of lower income, previouslyThere are no co-pays with SilverSummit Healthplan. Learn more about Nevada Medicaid today. Skip to Main Content. 1-844-366-2880; Home; Find a Provider; Login; Careers; Contact Us; language. English; Español ... Choose SilverSummit; Contact Us. SEARCH MENU. Go! 1-844-366-2880; Home; Find a Provider; Login; Careers; Contact Us; …Over-the-Counter Benefits | Allwell from Silver Summit Health. Get to Know Your OTC Benefit. Your Wellcare By Allwell plan includes an over-the-counter (OTC) …Colloidal silver is a popular alternative therapy that’s made a comeback in recent years. As with any other supplement or treatment, it’s a good idea to learn more before using it....If you would like to receive more information on becoming a provider within our network or would like to receive a contract, please contact us at 1-866-263-8134. Thank you for your interest in joining the Ambetter from SilverSummit HealthPlan provider network! Please contact us to inform us of your interest and view the provider manual.Behavioral Health services are handled by Silver Summit Health Plan. Musculoskeletal Surgical Services need to be verified by TurningPoint. Effective for dates of service 05/01/2024 forward, Cardiac Surgical Services also need to be verified by TurningPoint. The following services (identifiable by procedure code search) need to be …When SilverSummit members go to the doctor and do other healthy activities, they earn reward dollars they can spend at Walmart on groceries, clothing, electronics, school supplies, appliances, sports equipment, and other things they need. * Become a member today and start earning rewards while managing your health.Welcome to Ambetter from SilverSummit Healthplan (“Ambetter”). Thank you for participating in our network of participating physicians, hospitals, and other healthcare professionals. Ambetter is a Qualified Health Plan (QHP) as defined in the Affordable Care Act (ACA). Ambetter will beWe would like to show you a description here but the site won’t allow us.Every Ambetter insurance plan offers all of your Essential Health Benefits: Emergency services, outpatient or ambulatory services, preventive and wellness services, maternity and newborn care, pediatric services, mental health and substance abuse services, laboratory services, prescription drugs, therapy services (such as physical therapy) and ...If you want to know if a service needs authorization, you can call Member Services. The phone number is 1-844-366-2880, TTY: 1-844-804-6086, Relay 711. There is more information about this later in the handbook. See the … OUTPATIENT MEDICAID. Complete and Fax to: 1-844-367-7022 Transplant Request Fax to: 1-833-414-1503. What you need to know: Check Your Application Status! If you have Medicaid coverage, don’t risk losing your Medicare Advantage Dual Special Needs Plan (D-SNP) and Medicaid benefits. Welcome to Wellcare By Allwell's new Medicare Advantage website. We are simplifying Medicare so you can choose and use an affordable local plan that will help you ... Sep 14, 2023 ... Custom Ink Group Health Plan; Electrical Workers Health & Welfare Plan for ... SilverSummit Healthplan - Medicaid HMO***; TRICARE - Health Net ...Cultural Humility Resources. The health plan encourages our providers to engage in Cultural Humility trainings and education to promote positive interaction with diverse cultures. For more information about the Cultural and Linguistic Competency e-Learning Program from the Office of Minority Health (OMH), see … Healthy partnerships are our specialty. With Ambetter, you can rely on the services and support that you need to deliver the best quality of patient care. You’re dedicated to your patients, so we’re dedicated to you. When you partner with us, you benefit from years of valuable healthcare industry experience and knowledge. Go Now. Access all of your Ambetter member services from SilverSummit HealthPlan in one place! Find a provider, pay your premium, check your rewards balance, and more. Learn … If you have any questions or need more information on anything, please call us 8 a.m.-5 p.m. We are here for you. 1-844-366-2880 (TTY/TDD 1-844-804-6086) SilverSummit Healthplan welcomes all members and is dedicated to giving you quality care. Learn more about Nevada Medicaid today. Welcome to SilverSummit Healthplan, a dedicated member of the Centene family that has been proudly serving Nevada since 2017. We're not just a health insurance provider - …Dec 1, 2021 ... Nevada Members transitioning from Managed Care Plans: Anthem BCBS, Health. Plan of Nevada and Silver Summit Health Plan. As we prepare to go ...Please use the Grievance, Appeal or Concern Form or call Member Services at 1-844-366-2880 or TTY/TDD 1-844-804-6086. If you have been denied a service that you feel you should receive. please notify us as soon as possible. SilverSummit Healthplan hopes you're always happy with our services and providers of Medicaid in Nevada.Reimbursement will be sent to the Plan subscriber (see Help Sheet for definition) at the address Ambetter from SilverSummit Healthplan has on record (To view your address of record, please log on to Ambetter.SilverSummitHealthplan.com or call Member Services at 1-866-263-8134 (TDD/TTY: 1-855-868-4945). Careers. SilverSummit Healthplan is a wholly-owned subsidiary of Centene Corporation. We Succeed for Very Talented Reasons – Caring is more than a business opportunity with Centene. It is the reason we exist. It’s the reason we choose to excel. It’s the reason our employees nationwide are valued, respected and rewarded. AcariaHealth’s licensed pharmacists are also available to you 24/7 to discuss prescribed therapy and answer any questions regarding medications and supplies. AcariaHealth will work with your current specialty pharmacy provider to seamlessly transition your medications safely and efficiently. To get started, contact us at 1-800-511-5144.On December 9, 2022, SilverSummit Healthplan sent a postcard announcing certain 2023 Enhanced Over-the-Counter (OTC) benefits. Unfortunately, there was a typo in the Member Services phone number listed at the bottom of the postcard. If you have questions regarding your SilverSummit Healthplan benefits, please call (844) 366-2880, TTY (844) 804 ...OUTPATIENT MEDICAID. Complete and Fax to: 1-844-367-7022 Transplant Request Fax to: 1-833-414-1503. AcariaHealth’s licensed pharmacists are also available to you 24/7 to discuss prescribed therapy and answer any questions regarding medications and supplies. AcariaHealth will work with your current specialty pharmacy provider to seamlessly transition your medications safely and efficiently. To get started, contact us at 1-800-511-5144. We would like to show you a description here but the site won’t allow us.Whether you are an automotive enthusiast or a professional mechanic, finding the right parts for your vehicle is crucial. When it comes to performance upgrades and modifications, S...SilverSummit Healthplan Nevada Health Insurance exists to improve the health of its beneficiaries through focused, compassionate & coordinated care with the right health plan in Nevada. ... Choose SilverSummit; Contact Us. SEARCH MENU. Go! 1-844-366-2880; Home; Find a Provider; Login; Careers;
When you begin shopping for a Marketplace health plan, you’ll see plan options with different metal tiers such as Gold, Silver and Bronze plans. But the only difference between these plans is how much premium you’ll pay each month and how much you’ll pay for certain medical services. A Bronze plan typically gives you lower monthly premium ... . Play games online earn cash money
When you begin shopping for a Marketplace health plan, you’ll see plan options with different metal tiers such as Gold, Silver and Bronze plans. But the only difference between these plans is how much premium you’ll pay each month and how much you’ll pay for certain medical services. A Bronze plan typically gives you lower monthly premium ... Prior Authorization. Please note, failure to obtain authorization may result in administrative claim denials. SilverSummit Healthplan providers are contractually prohibited from holding any member financially liable for any service administratively denied by SilverSummit Healthplan for the failure of the provider to obtain timely authorization. Specialties: SilverSummit Healthplan is a managed care organization that will provide healthcare services to Nevada Medicaid and Nevada Check Up members in Clark and Washoe counties. SilverSummit Healthplan has a commitment to improving the health of the community one individual at time. We're here to treat …Behavioral Health services are handled by Silver Summit Health Plan. Musculoskeletal Surgical Services need to be verified by TurningPoint. Effective for dates of service 05/01/2024 forward, Cardiac Surgical Services also need to be verified by TurningPoint. The following services (identifiable by procedure code search) need to be …Silver Summit Healthplan Smart Choice Medicaid (HPN Medicaid) State of ... Alignment Health Plan Ambetter AZ Complete Health Banner University HealthplansCall Ambetter Health billing services to pay by phone. Pay using our Interactive Voice Response (IVR) system. Or if you need help, talk to a representative at 1-866-263-8134 ( TTY 1-855-868-4945 ). For Additional Ways to Pay, by mail or MoneyGram®, log into your member account or look on the back of your invoice …We would like to show you a description here but the site won’t allow us.Behavioral Health services are handled by Silver Summit Health Plan. Musculoskeletal Surgical Services need to be verified by TurningPoint. Effective for dates of service 05/01/2024 forward, Cardiac Surgical Services also need to be verified by TurningPoint. The following services (identifiable by procedure code search) need to be …Welcome to Ambetter from SilverSummit Healthplan (“Ambetter”). Thank you for participating in our network of participating physicians, hospitals, and other healthcare professionals. Ambetter is a Qualified Health Plan (QHP) as defined in the Affordable Care Act (ACA). Ambetter will beSilverSummit Healthplanonly accepts the CMS 1500 (2/12) and CMS 1450 (UB-04) paper claim forms. Other claim form types will be rejected and returned to the provider. Professional providers and medical suppliers complete the CMS 1500 (2/12) form and institutional providers complete the CMS 1450 (UB-04) claim form. SilverSummit …Call us at 1-866-263-8134 ( TTY 1-855-868-4945) or contact your broker directly. Remember to check Ambetter Health's 2024 Preferred Drug List for all covered drug updates. Great coverage and benefits just for you. As an Ambetter Health member, you have access to a variety of benefits.The provider’s role in SilverSummit Healthplan's Care Coordination program is extremely important. Practitioners who have identified a member who they think would benefit from disease or case management should contact the Care Coordination Department to speak with a member of our Integrated Care Team at 1-844-366-2880.Healthy partnerships are our specialty. With Ambetter, you can rely on the services and support that you need to deliver the best quality of patient care. You’re dedicated to your patients, so we’re dedicated to you. When you partner with us, you benefit from years of valuable healthcare industry experience and knowledge. SilverSummit Healthplan provides tools and support our providers need to deliver the best quality of care for Nevada Medicaid beneficiaries. View our resources ... Policies in the SilverSummit Healthplan Payment Policy Manual may have either a SilverSummit Healthplan or a “Centene” heading. In addition, SilverSummit Healthplan may from time to time employ a vendor that applies payment policies to specific services; in such circumstances, the vendor’s guidelines may also be used to determine whether a … Prior Authorization. Please note, failure to obtain authorization may result in administrative claim denials. SilverSummit Healthplan providers are contractually prohibited from holding any member financially liable for any service administratively denied by SilverSummit Healthplan for the failure of the provider to obtain timely authorization. SilverSummit Healthplan will conduct random medical record audits as part of its QI program to monitor compliance with the medical record documentation standards. The coordination of care and services provided to members, including over/under utilization of specialists, as well as the outcome of such services also may be assessed during a ….