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 and NPI as requested on the Registration page of the Web Portal. Please contact Simply via e-mail should additional assistance be required.


Managed Medical Assistance (MMA) Provider Materials

Useful Materials for Medicare Providers

Provider Directories

Region 11 SHP Miami Dade and Monroe Directory                                                                                                                                                                            October 2014

Prior Authorization Forms

TitleLast Updated
Medication Prior Authorization Fuzeon (MEDICAID ONLY)February 2012
Medication Prior Authorization HIV-HEP-B Diagnosis Verification (MEDICAID ONLY)February 2012
Medication Prior Authorization Selzentry Maraviroc (MEDICAID ONLY)February 2012
Medication Prior Authorization SerostimFebruary 2012
Synagis Request (MEDICAID ONLY)February 2012
Medicaid Prior Authorization & Step Therapy MEDICAID ONLYDecember 2011

Downloads

TitleLast Updated
Informed Consent FormAugust 2012
OB Provider Pregnancy Assessment Form – Use for Medicaid and MedicareJuly 2012
Diabetes SuppliesJanuary 2012
Helping Smokers Quit, A Guide for CliniciansFebruary 2012

Health & Wellness Information

We Can! Ways to Enhance Children's Activity & Nutrition
We Can! is a national movement designed to give parents, caregivers, and entire communities a way to help children 8 to 13 years old stay at a healthy weight. For more information, click here

Promoting Breastfeeding: 
http://www.uspreventiveservicestaskforce.org/uspstf08/breastfeeding/brfeedrs.pdf

Folic Acid Supplementation fr Prevention of Neural tube defects in your baby: 
http://www.uspreventiveservicestaskforce.org/uspstf09/folicacid/folicacidrs.pdf

National Kidney Foundation KDOGI Guidelines: 
http://www.kidney.org/professionals/KDOQI/guidelines_ckd/p9_approach.htm.

Hypertension and Antihypertensive Agents in Chronic Kidney Disease - National Kidney Foundation: 
http://www.kidney.org/professionals/KDOQI/guidelines_bp/index.htm

Chronic Heart Failure: ACC/AHA 2005 Guideline update: A report f the ACC/AHA task force on practice guidelines: 
http://circ.ahajournals.org/content/112/12/e154

Screening for Bacterial Vaginosis in Pregnancy:
http://www.uspreventiveservicestaskforce.org/uspstf08/bv/bvrs.pdf

Gestational DM Screening: 
http://www.uspreventiveservicestaskforce.org/uspstf08/gestdiab/gdrs.pdf

For information about diabetes, click: 
www.diabetes.org

Asthma Quick Care Reference Guide, click:
http://www.nhlbi.nih.gov/guidelines/asthma/asthma_qrg.pdf


Psychcare

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

Simply Provider Newsletter


Simply Medicare Provider Bulletins


Simply Medicaid Provider Bulletins

Bulletin Volume 1, Issue 1- Jan.1, 2012 - In Office Lab Services Reimbursement Begins for Medicaid FFS PCP’s
Bulletin Volume 1, Issue 2- March 8, 2012 - Simply is Live with Availity
Bulletin Volume 1, Issue 3- Sept. 26, 2012- Vaccines for Children
Bulletin Volume 1, Issue 4- Nov.1, 2012- Pharmacy Notice
Bulletin Volume 1, Issue 5- Dec. 1, 2012- Provider Portal Enhancements
Bulletin Volume 1, Issue 6- Jan. 1, 2013- AAAHC
Bulletin Volume 1, Number 2 - Electronic Claim Submission through EMDEON (UPDATED 04/20/11)
Bulletin Volume 1, Number 1 - New Corporate Address 

Evidence Based Guidelines

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

Medication Alerts from AHCA

AHCA Alert - HIV or Hepatitis C Medications and Statins - July 2012

Claims Submission

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

Simply Healthcare Plans
PO Box 21535
Eagan, MN 55121

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.

ICD-10 Readiness Assessment Survey

How Ready Are You? Find out in minutes.

Simply Healthcare is committed to ensuring that its providers are ready for the conversion to ICD-10 on October 1, 2015.

To support you throughout the ICD-10 conversion process, we have designed a brief Readiness Assessment Survey. Completion of the 26-question survey will help us establish a baseline measure of your readiness and guide us in assisting you though a successful ICD-10 conversion. 

Provider Readiness Survey

We appreciate your participation in the Simply Healthcare ICD-10 Readiness Assessment Survey and look forward to working with you to ensure a smooth conversion.