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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

Region 11 SHP Miami-Dade & Monroe DirectoryJuly 2016

Useful Materials for Medicaid Providers

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

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 GuidelinesJuly 2016
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

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

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

Incident Reporting Forms

HIPAA Breach Report FormOctober 2015
Risk Management Report FormFebruary 2016

Health & Wellness Information

Behavioral Health

For information about Beacon go to:

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


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

UM 708 (A) MA Clinical Practice Guidelines - Medicaid & Medicare

UM 708(C) MA Preventive 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.


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