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

TITLE LAST UPDATED
Region 11 SHP Miami-Dade & Monroe Directory May 2016

Useful Materials for Medicaid Provider

TITLE LAST UPDATED
AAAHC - CM/DM Information for Website February 2016
Annual Satisfaction Survey for 2015 February 2016
Annual Satisfaction Survey for 2013 February 2016
Provider Manual February 2016
Express Enrollment Bulletin January 2016
Provider Claims Dispute Form January 2016
Provider Claims Review Form January 2016
Important information for Referrals or Prior Authorizations January 2016
Cultural Competency Plan September 2015
Physician Cultural Competency Independent Training Module September 2015
Child Health Check-up Visits Coding Requirements May 2014
Pregnancy Notification Form May 2014
OB Provider Pregnancy Assessment Form May 2014

Useful Materials for Medicare Providers

TITLE LAST UPDATED
Provider Offices are Crucial to Excellent CAHPS & HOS Survey Performance March 2016
Medicare Provider Manual February 2016
SNP Model of Care Annual Evaluations for 2015 May 2016
SHP Code of Business Ethics March 2016
CMS Medicare Marketing Guidelines June 2014
High Risk Drug Guide January 2014
Simply Medicare Special Needs Plans  
Waiver of Liability Statement June 2014
CMS Transmittals and National Coverage Determinations (NCD) March 2015
National Coverage Determinations March 2015
Medicare Learning Network Matters Articles March 2015
Important information for Referrals or Prior Authorizations January 2016
Medicare Non-Participating Provider Appeals Form January 2016
Provider Claims Review Form January 2016
FDR Medicare Compliance Documents, Training & Attestation Requirements
Conflict of Interest Policy March 2016
FDR Attestation  March 2016
COM-MCR-01 Compliance Program March 2016
COM-MCR-02 Code of Conduct & Code of Business Ethics March 2016
COM-MCR-03 Compliance Officer March 2016
COM-MCR-04 Compliance Committee March 2016
COM-MCR-05 Effective Training & Education March 2016
COM-MCR-06 Compliance Awareness March 2016
COM-MCR-07 Non-Intimidation & Non-Retaliation Policy for Reporting Violations March 2016
COM-MCR-08 Disciplinary Standards - Corrective Action Policy March 2016
COM-MCR-09 Conflict of Interest & Outside Employement March 2016
COM-MCR-10 Reporting Non-Compliance Incidents March 2016
COM-MCR-11 Compliance Program High Level Oversight March 2016
COM-MCR-12 Effective Lines of Communication March 2016
COM-MCR-13 Exclusions Screenings March 2016
COM-MCR-14 Compliance Responce to Detected Offenses & Investigation March 2016
COM-MCR-15 Compliance Program Effectiveness March 2016
COM-MCR-16 Effective Monitoring & Auditing March 2016
COM-MCR-19 Reporting Non-Compliance Incidents to the CEO & Governing Body March 2016

Provider Trainings

TITLE LAST UPDATED
Compliance Fraud, Waste and Abuse Training April 2016
Model of Care Training for Simply Healthcare SNP Providers March 2016
Provider Orientation May 2014
SHP Medicare Compliance Training March 2016
Behavioral Health Screening, Referral, and Coding Requirements Training February 2015
Behavioral Health Screening Coding Requirements February 2015

Prior Authorization Forms

TITLE LAST UPDATED
Request for Services Requiring Prior Authorization July 2015
Medication Prior Authorization Form March 2015

Incident Reporting Forms

TITLE LAST UPDATED
HIPAA Breach Report Form October 2015
Risk Management Report Form February 2016

Health & Wellness Information

We Can! Ways to Enhance Children's Activity & NutritionWe 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

Folic Acid Supplementation for Prevention of Neural tube defects in your baby

National Kidney Foundation KDOGI Guidelines

Chronic Heart Failure: ACC/AHA 2005 Guideline update: A report f the ACC/AHA task force on practice guidelines

Diabetes

Diabetes Supplies

Helping Smokers Quit, A Guide for Clinicians

Asthma Quick Care Reference Guide

Behavioral Health

Concordia
For information about Concordia go to: http://www.concordiabh.com

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

Simply Provider Newsletter

AHCA Medication Criteria

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