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

Region 11 SHP Miami-Dade & Monroe DirectoryNovember 2015

Useful Materials for Medicaid Provider

Provider ManualMay 2014
Child Health Check-up Visits Coding RequirementsMay 2014
Pregnancy Notification FormMay 2014
OB Provider Pregnancy Assessment FormMay 2014
Cultural Competency PlanSeptember 2015
Physician Cultural Competency Independent Training ModuleSeptember 2015

Useful Materials for Medicare Providers

Medicare Provider ManualMarch 2014
SNP Model of Care Annual Evaluations for 2014June 2015
SHP Code of Business EthicsJanuary 2013
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

Provider Trainings

Provider OrientationMay 2014
Provider SNP Model of Care TrainingMay 2015
SHP Medicare Compliance TrainingNovember 2013
Behavioral Health Screening, Referral, and Coding Requirements TrainingFebruary 2015
Behavioral Health Screening Coding RequirementsFebruary 2015

Prior Authorization Forms

Request for Services Requiring Prior Authorization July 2015
Medication Prior Authorization FormMarch 2015

Incident Reporting Forms

HIPPA Breach Report FormOctober 2015
Risk Management Report FormMay 2015

Health & Wellness Information

Behavioral Health

For information about Concordia go to:

For information about Psychcare go to:
For Provider manual click here

Simply Provider Newsletter

AHCA Medication Criteria

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

Evidence Based Guidelines

UM001(i) Clinical Practice Guidelines Reference Guide - Medicaid

UM708(A) MA Clinical Practice Guidelines Reference Guide - Medicare

UM304(B) MA Preventative Services Reference Guide - Medicare & Medicaid

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.


Healthwise Module - Check your Symptoms