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 DirectoryMarch 2015

Managed Medical Assistance (MMA) Provider Materials

Useful Materials for Medicare Providers

Prior Authorization Forms

TITLELAST UPDATED
Simply Healthcare Plans General Medicaid Medication Prior Authorization FormMarch 2015
Simply Healthcare Plans General Medicare Medication Prior Authorization FormMarch 2015
AHCA MEDICATION CRITERIAFORM LINK
Abstral/Actiq/Fentora/Lazanda/Onsolis/Subsys Updated 8/4/2014
Albumin Updated 8/4/2014
Antidepressants (Age <6 years) Updated 12/11/2014
Antipsychotic (Age <6 years of age) Updated 12/11/2014
Antipsychotic (Age 6 to < 18 years of age) Updated 12/11/2014
Botox Updated 8/4/2014
Cytogam Updated 6/17/14
Fuzeon Updated 6/9/2014
Harvoni New 11/12/2014
HIV Diagnosis Verification Updated 8/4/2014
Human Growth Hormone  Updated 2/26/2015
Human Growth Hormone for HIV Wasting in Adults (Serostim) Updated 6/9/2014
Increlex Updated 7/11/2014
Miscellaneous Pharmacy Prior Authorization Requests Updated 8/4/2014
Request for Multi-Source Brand Drugs Updated 7/10/2014
Neupogen/Leukine/Neulasta/Granix Updated 8/4/2014
Oral Oncology Agents Updated 8/4/2014
Orfadin Updated 8/4/2014
Oxycontin ER Oxycontin  Updated 8/4/2014
Panretin Updated 8/4/2014
Procrit/Aranesp Updated 8/4/2014
Proleukin Updated 6/17/14
Provigil Updated 8/4/2014
Selzentry Updated 6/9/2014
Soma Updated 8/4/2014
Sovaldi Updated 11/12/2014
Sovaldi Kick Payment New 7/16/2014
Suboxone/Subutex/Zubsolv Updated 2/17/2015
Supprelin LA Updated 8/4/2014
Synagis - All Florida Regions Combined Updated 10/23/2014
Synagis - Weight Change Updated 8/4/2014
Tobi Updated 8/4/2014
Valcyte Updated 8/4/2014
Viekira New 2/4/2015
Vfend Updated 6/17/2014

Provider Trainings

TITLELAST UPDATED
Behavioral Health Screening, Referral, and Coding Requirements TrainingFebruary 2015
Behavioral Health Screening Coding RequirementsFebruary 2015

Downloads

TitleLast Updated
Diabetes SuppliesJanuary 2015
Helping Smokers Quit, A Guide for CliniciansJanuary 2015

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
 
Useful tools: 

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


Evidence Based Guidelines

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

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.