Provider Services

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 Directories

The forms you download here are viewable using Acrobat Reader.

TitleLast Updated
Dade - Medicaid Provider DirectoryApril 2014
Orlando - Medicaid Provider DirectoryApril 2014
Polk - Medicaid Provider DirectoryApril 2014
Tampa - Medicaid Provider DirectoryApril 2014

Prior Authorization Forms

TitleLast Updated
Medication Prior Authorization Form - Use for Medicaid and Medicare February 2012
Medication Prior Authorization Fuzeon MEDICAID ONLYFebruary 2012
Medication Prior Authorization HIV-HEP-B Diagnosis Verification MEDICAID ONLYFebruary 2012
Medication Prior Authorization Selzentry Maraviroc MEDICAID ONLYFebruary 2012
Medication Prior Authorization SerostimFebruary 2012
Synagis Request MEDICAID ONLYFebruary 2012

Medicaid Prior Authorization & Step Therapy MEDICAID ONLY

December 2011


The forms you download here are viewable using Acrobat Reader.

TitleLast Updated
Medicaid Comprehensive Formulary September 2013
Informed Consent FormAugust 2012
OB Provider Pregnancy Assessment Form – Use for Medicaid and MedicareJuly 2012
Diabetes SuppliesJanuary 2012
Simply Exclusive Participating Provider NetworksJanuary 2013
Medicaid Provider HandbookJanuary 2013
Medicaid Reform Provider HandbookJanuary 2013
PreAuthorization Form (to be completed by the prescribing physician)February 2013
Helping Smokers Quit, A Guide for CliniciansFebruary 2012
Cultural Competency and Minority Recruitment PlanAugust 2012 

Useful Plan Materials for Medicare Providers

Important Provider Notification

Health & Wellness Information



For information about diabetes, click


Asthma Quick Care Reference Guide, click:


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

Simply Provider Newsletter

Simply Medicare Provider Bulletins

Third Party Oversight of Non-Health Related Items - Issued February 28, 2014

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


IMPORTANT NOTICE REGARDING Simply Healthcare Plans NEW CORPORATE OFFICE ADDRESS and PO BOX, see Provider Bulletin below

Provider Web Portal

In an effort to serve you better, Simply Healthcare Plans has instituted a new Provider Portal for its Simply Medicaid and Healthy Kids lines of business. Effective September 27, 2010, you may access the Simply Web Portal. 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.

Evidence Based Guidelines

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

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, 2014.

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.