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Provider Services

Provider Portal

In an effort to serve you better, Simply Healthcare Plans provides a Provider Portal for its Simply Medicaid and Medicare lines of business. The following services are available via the Provider Portal:

  • Eligibility verification
  • Claim Status
  • Referral Entry and Status Review

You may register, as a participating provider, on the Simply Provider Portal by entering your Tax Identification Number, NPI and Entity ID (a unique access code generated by Simply Healthcare) as requested on the Registration page of the Web Portal. Please contact Simply via e-mail or by phone in order to obtain the Entity ID.


Provider Directory

TITLELAST UPDATED
Region 11 SHP Miami-Dade & Monroe DirectoryJune 2016

Useful Materials for Medicaid Providers

TITLELAST UPDATED
AAAHC - CM/DM Information for WebsiteFebruary 2016
Annual Satisfaction Survey for 2015February 2016
Annual Satisfaction Survey for 2013February 2016
Provider ManualFebruary 2016
Express Enrollment BulletinJanuary 2016
Provider Claims Dispute FormJanuary 2016
Provider Claims Review FormJanuary 2016
Important information for Referrals or Prior AuthorizationsJanuary 2016
Cultural Competency PlanSeptember 2015
Physician Cultural Competency Independent Training ModuleSeptember 2015
Child Health Check-up Visits Coding RequirementsMay 2014
Pregnancy Notification FormMay 2014
OB Provider Pregnancy Assessment FormMay 2014

Useful Materials for Medicare Providers

TITLELAST UPDATED
Provider Offices are Crucial to Excellent CAHPS & HOS Survey PerformanceMarch 2016
Medicare Provider ManualMay 2016
SNP Model of Care Annual Evaluations for 2015May 2016
SHP Code of Business EthicsMarch 2016
CMS Medicare Marketing GuidelinesJune 2014
High Risk Drug GuideJanuary 2014
Simply Medicare Special Needs Plans 
Waiver of Liability StatementJune 2014
CMS Transmittals and National Coverage Determinations (NCD)March 2015
National Coverage DeterminationsMarch 2015
Medicare Learning Network Matters ArticlesMarch 2015
Important information for Referrals or Prior AuthorizationsJanuary 2016
Medicare Non-Participating Provider Appeals FormJanuary 2016
Provider Claims Review FormJanuary 2016
FDR Medicare Compliance Documents, Training & Attestation Requirements
Conflict of Interest PolicyMarch 2016
FDR Attestation March 2016
COM-MCR-01 Compliance ProgramMarch 2016
COM-MCR-02 Code of Conduct & Code of Business EthicsMarch 2016
COM-MCR-03 Compliance OfficerMarch 2016
COM-MCR-04 Compliance CommitteeMarch 2016
COM-MCR-05 Effective Training & EducationMarch 2016
COM-MCR-06 Compliance AwarenessMarch 2016
COM-MCR-07 Non-Intimidation & Non-Retaliation Policy for Reporting ViolationsMarch 2016
COM-MCR-08 Disciplinary Standards - Corrective Action PolicyMarch 2016
COM-MCR-09 Conflict of Interest & Outside EmployementMarch 2016
COM-MCR-10 Reporting Non-Compliance IncidentsMarch 2016
COM-MCR-11 Compliance Program High Level OversightMarch 2016
COM-MCR-12 Effective Lines of CommunicationMarch 2016
COM-MCR-13 Exclusions ScreeningsMarch 2016
COM-MCR-14 Compliance Responce to Detected Offenses & InvestigationMarch 2016
COM-MCR-15 Compliance Program EffectivenessMarch 2016
COM-MCR-16 Effective Monitoring & AuditingMarch 2016
COM-MCR-19 Reporting Non-Compliance Incidents to the CEO & Governing BodyMarch 2016

Provider Trainings

TITLELAST UPDATED
Compliance Fraud, Waste and Abuse TrainingApril 2016
Model of Care Training for Simply Healthcare SNP ProvidersMarch 2016
Provider OrientationMay 2014
SHP Medicare Compliance TrainingMarch 2016
Behavioral Health Screening, Referral, and Coding Requirements TrainingFebruary 2015
Behavioral Health Screening Coding RequirementsFebruary 2015

Prior Authorization Forms

TITLELAST UPDATED
Request for Services Requiring Prior AuthorizationMay 2016
Medication Prior Authorization FormMarch 2015

Incident Reporting Forms

TITLELAST UPDATED
HIPAA Breach Report FormOctober 2015
Risk Management Report FormFebruary 2016

Health & Wellness Information

Behavioral Health

Beacon
For information about Beacon go to: 
http://www.beaconhealthoptions.com/members/

Psychcare
For information about Psychcare go to: http://www.psychcare.com
For Provider manual click here

Simply Provider Newsletter

AHCA Medication Criteria

TITLEFORM LINK
Abstral/Actiq/Fentora/Lazanda/Onsolis/Subsys Updated 8/4/2014http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/Abstral-Actiq-Fentora-Lazanda-Onsolis-Subsys_Form.pdf
Albumin Updated 8/4/2014http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/Albumin_Form.pdf
Antidepressants (Age <6 years) Updated 12/11/2014http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/Albumin_Form.pdf
Antipsychotic (Age <6 years of age) Updated 12/11/2014http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/Antipsychotic_6Years_Form.pdf
Antipsychotic (Age 6 to < 18 years of age) Updated 12/11/2014http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/Antipsychotic_Under18_Form.pdf
Botox Updated 8/4/2014http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/Botox_Form.pdf
Cytogam Updated 6/17/14http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/FL_PA_Cytogam_Form.pdf
Fuzeon Updated 6/9/2014http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/FL_PA_Fuzeon_Form.pdf
Harvoni New 11/12/2014http://www.fdhc.state.fl.us/Medicaid/Prescribed_Drug/pharm_thera/paforms/Harvoni_PA_Form.pdf
HIV Diagnosis Verification Updated 8/4/2014http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/HIV_Diagnosis_Verification_Form.pdf
Human Growth Hormone Updated 2/26/2015http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/Human_Growth_Hormore_Form.pdf
Human Growth Hormone for HIV Wasting in Adults (Serostim) Updated 6/9/2014http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/SEROSTIM_PA_Form.pdf
Increlex Updated 7/11/2014http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/Increlex_Form.pdf
Miscellaneous Pharmacy Prior Authorization Requests Updated 8/4/2014http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/Pharm_Misc_Form.pdf
Request for Multi-Source Brand Drugs Updated 7/10/2014http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/Request_Multi_Source_Brand_Drug.pdf
Neupogen/Leukine/Neulasta/Granix Updated 8/4/2014http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/Request_Multi_Source_Brand_Drug.pdf
Oral Oncology Agents Updated 8/4/2014http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/Oral_Oncology_Agents_Form.pdf
Orfadin Updated 8/4/2014http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/Orfadin_Form.pdf
Oxycontin ER Oxycontin Updated 8/4/2014http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/Oxycodone_ER_Oxycontin_Form.pdf
Panretin Updated 8/4/2014http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/Panretin_Form.pdf
Procrit/Aranesp Updated 8/4/2014http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/Procrit_Aranesp_Form.pdf
Proleukin Updated 6/17/14http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/FL_PA_Proleukin_Form.pdf
Provigil Updated 8/4/2014http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/Provigil_Form.pdf
Selzentry Updated 6/9/2014http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/FL_PA_Selzentry_Form.pdf
Soma Updated 8/4/2014http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/Soma_Form.pdf
Sovaldi Updated 11/12/2014http://www.fdhc.state.fl.us/Medicaid/Prescribed_Drug/pharm_thera/paforms/Sovaldi_Form.pdf
Sovaldi Kick Payment New 7/16/2014http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/Sovaldi_Kickpayment_Form.pdf
Suboxone/Subutex/Zubsolv Updated 2/17/2015http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/Suboxone_Subutex_Form.pdf
Supprelin LA Updated 8/4/2014http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/SUPPRELIN_LA_FORM.pdf
Synagis - All Florida Regions Combined Updated 10/23/2014http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/Synagis_All_Florida_Regions_Combined_Form.pdf
Synagis - Weight Change Updated 8/4/2014http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/Synagis_Weight.pdf
Tobi Updated 8/4/2014http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/Tobi_Form.pdf
Valcyte Updated 8/4/2014http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/Valcyte_Form.pdf
Viekira New 2/4/2015http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/Viekira_Form.pdf
Vfend Updated 6/17/2014http://www.fdhc.state.fl.us/medicaid/Prescribed_Drug/pharm_thera/paforms/FL_PA_Vfend_Form.pdf
 

Evidence Based Guidelines

UM708(A) Clinical Practice Guidelines Reference Guide - Medicaid & Medicare

UM708(A) MA Clinical Practice Guidelines Reference GuideMedicaid & Medicare

UM708(C) Preventative Services Reference GuideMedicaid & Medicare

UM708(B) Recommended Diabetes Practice GuidelinesMedicaid & Medicare

A copy of the guidelines are available upon request by calling the Provider Services number.

Claim Submission

All paper claims should be sent to the following new address:

 
Simply Healthcare Plans
PO Box 21535
Eagan, MN 55121
 
Electronic Claims: Preferred Vendor Emdeon (Payor ID: 27094)

 

Provider Contact

Eligibility Verification System

For membership eligibility and verification, call our Digital Voice Assistant at (877) 915-0551.

Enter Member's Medicaid ID or Member's Healthplan ID as it appears on their ID card.

Problems? Dial 0 to speak with a representative.

 

Healthwise Module - Check your Symptoms