Claims Submissions and Appeals

Claims submission and disputes

Simply Healthcare Plans, Inc. uses the Availity Portal, a secure, full-service web portal that offers a claims clearinghouse and real-time transactions at no charge to health care professionals. Use Availity to submit claims, check the status of all your claims, appeal a claim decision and much more.

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Finding claims tools on Availity:

Submit claims:

From the Availity homepage, choose Claims & Payments from the top navigation.
Select Type of Claim from the drop-down menu.

Claims status inquiry:

From the Availity homepage, select Claims & Payments from the top navigation.
Select Claims Status Inquiry from the drop-down menu.

Claims dispute:

To check claims status or dispute a claim:

From the Availity homepage, select Claims & Payments from the top navigation.
Select Claim Status Inquiry from the drop-down menu.
Submit an inquiry and review the Claims Status Detail page.
If the claim is denied or final, there will be an option to dispute the claim. Select Dispute the Claim to begin the process. You’ll be redirected to the Payer site to complete the submission.

Clear Claims Connection:

To use Clear Claims Connection:

From the Availity homepage, select Payer Spaces from the top navigation.
Select the appropriate health plan.
From the Payer Spaces homepage, select the Applications tab.
Select the Clear Claims Connection tile.

Related resources

Precertification

Precertification Forms

Provider tools & resources