Forms

This is a library of the forms most frequently used by health care professionals. Looking for a form but don't see it here? Please contact your provider representative at ARProviderQuestions@Summitcommunitycare.com or by calling 1-844-462-0022 for assistance.

Additional forms can be found on the Arkansas Department of Human Services and Arkansas Medicaid websites.

Provider tools & resources

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Prior Authorization Lookup Tool
Prior Authorization Information
Claims Overview
Member Eligibility & Pharmacy Overview

Provider Manuals and Guides
Referrals
Forms
Provider Education
Pharmacy Information
Electronic Data Interchange

Interested in becoming a provider in the Summit Community Care Network?

We look forward to working with you to provide quality service for our members.

All services referenced in this material are funded and provided under an agreement with the Arkansas Department of Human Services.

Contact Us

Write to:
Provider Relations
Summit Community Care
650 S. Shackleford Road, Suite 440
Little Rock, AR 72211