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Providers

Welcome, providers!

Resources that help health care professionals do what they do best — care for our members.

At Simply Healthcare Plans, Inc. (Simply), we value you as a provider in our network. That's why we’ve redesigned the provider site to make it more useful for you and easier to use.

Looking for access to Simply’s legacy portal?

Need help regarding services rendered prior to the health plan’s transition to Availity?

For Medicaid transactions prior to rollout of the new Statewide Medicaid Managed Care Managed Medical Assistance contract, please visit the previous provider portal.

For Medicare member eligibility and benefits lookup before January 1, 2019, please visit the previous provider portal.

Provider news


The latest articles and announcements on claims filings, products, benefits, administrative updates, new and revised procedures and guidelines, prescription information, and more.

Medicaid updates

July 2018 Medical Policies and Clinical Utilization Management Guidelines Update

The Medical Policies and Clinical Utilization Management (UM) Guidelines below were developed or revised to support clinical coding edits. Note, several policies and guidelines were revised to provide clarification only and are not included. Existing precertification requirements have not changed. For markets with carved-out pharmacy services, the applicable listings below are informational only.

Amerigroup rebrand reminder for Florida Healthy Kids providers

This notice serves to remind Florida Healthy Kids (FHK) providers that, effective December 1, 2018, for regions 6, 7, 10 and 11, Amerigroup was rebranded to Simply Healthcare Plans, Inc. (Simply).

Authorization, precertification and referral process reminder

This notice serves to remind providers and facilities that there are three ways to submit an authorization or precertification request to Simply Healthcare Plans, Inc. and Clear Health Alliance (Simply): electronically via the Availity Portal, by fax or by phone.

Quarterly pharmacy formulary change notice effective February 1, 2019

The formulary changes listed in the table were reviewed and approved at our third quarter, Pharmacy and Therapeutics Committee meeting. Effective February 1, 2019, the changes outlined apply to all Florida Healthy Kids (FHK) members enrolled with Simply Healthcare Plans, Inc. (Simply).

Services Requiring Prior Authorization

All programs require prior authorization (PA) for all specialty medications, where allowable by state. The scope of this notice will include both professional and facility requests for Medicaid business.

Integrated Home Care Services announcement

Effective on the regional rollout of the new Statewide Medicaid Managed Care Managed Medical Assistance program with Simply Healthcare Plans, Inc. and Clear Health Alliance (Simply), we have entered into an agreement with Integrated Home Care Services (IHCS) for home health, durable medical equipment and home infusion services to our Medicaid members.

Continuity of Care Provider Notice

This notice serves to remind Simply Healthcare Plans, Inc. and Clear Health Alliance (Simply) providers and subcontractors who will not continue to participate with the plan under the new Statewide Medicaid Managed Care Managed Medical Assistance (SMMC MMA) contract of the continuity of care contract requirements post-termination.

Simply Healthcare Plans, Inc. and Clear Health Alliance EIS and TCM Continuity of Care Processes

This notice serves to provide information to Early Intervention Services (EIS) and Children’s Health Targeted Case Management (TCM) providers concerning Statewide Medicaid Managed Care Managed Medical Assistance (SMMC MMA) continuity of care (COC) requirements for new members who transition into Simply Healthcare Plans, Inc. and Clear Health Alliance (Simply).

Reimbursement Policy Update Notification

Effective December 1, 2018, reimbursement policies will transition to the Simply Healthcare Plans, Inc. and Clear Health Alliance (Simply) provider website.

Looking for previous records?

Need help regarding services rendered prior to the health plan’s transition to the new provider website or services rendered prior to the health plan’s transition to Availity? Visit the previous provider portal

Provider Services phone numbers are changing

Medicaid and Medicare Advantage providers for Simply Healthcare Plans, Inc. will have new toll-free phone numbers specifically designated for their service inquiries.

 

Medicare updates

Authorization, precertification and referral process reminder

This notice serves to remind providers and facilities that there are three ways to submit an authorization or precertification request to Simply Healthcare Plans, Inc. and Clear Health Alliance (Simply): electronically via the Availity Portal, by fax or by phone.

Medicare Advantage claims and correspondence information

Effective for dates of service January 1, 2019 and after, Simply Healthcare Plans Inc. Medicare Advantage claims will transition to a new claims system. This will change the way that claims, correspondence, appeals, claim reviews and disputes are submitted to Simply. The following information will help you ensure that your Medicare Advantage claims are processed accurately.

Looking for previous records?

Need help regarding services rendered prior to the health plan’s transition to the new provider website or services rendered prior to the health plan’s transition to Availity? Visit the previous provider portal

Electronic data interchange moving to the Availity Portal

Effective December 1, 2018, the Availity Portal will be your partner for electronic data interchange (EDI) services. You may already be familiar with the Availity Portal as a claims clearinghouse, but it can do much more — it is also an intelligent EDI Gateway for multiple payers and will soon be the single EDI connection for Simply Healthcare Plans, Inc.

Provider Services phone numbers are changing

Medicaid and Medicare Advantage providers for Simply Healthcare Plans, Inc. will have new toll-free phone numbers specifically designated for their service inquiries.

 

Provider offices are crucial to Medicare CAHPS and HOS survey performance

Each spring, some of your patients are asked to complete a CAHPS® or HOS survey. These surveys are an important tool to help us monitor how our members think we are doing. The results of these surveys are available to the public on the Medicare Plan Finder website and have a direct impact on the plan’s Star rating. It is important to remember that our performance on these surveys is based on patients’ perceptions, not clinical outcomes.

 

Availity access


The Availity Portal offers health care professionals free access to real-time information and instant responses in a consistent format regardless of the payer.

At Availity, you can:

Request Authorizations.
Submit Claims.
Confirm Eligibility.

Don't have an Availity account? Register for free now!

Availity is your one-stop to complete your transactions

Featured resources


Pharmacist looking at prescription bottle

Pharmacy Information

Search for up-to-date drug information, including hundreds of brand-name and generic medications.

Expectant mother sharing ultrasound

Maternal Child Program

We offer a proactive case-management program for expectant mothers and their newborns. The My Advocate™ program provides pregnant women with proactive outreach and education through interactive voice response (IVR), text or smartphone application.

Patient talking with counselor

Behavioral health provider

We work collaboratively with hospitals, group practices and independent behavioral health care providers, community and government agencies, human service districts and other resources to successfully meet the needs of members with mental health, substance use, and intellectual and developmental disabilities.

Provider survey


We want to hear from you! Please help us improve our provider website by taking this brief survey.

Provider tools & resources

Interested in becoming a provider in the Simply network?

We look forward to working with you to provide quality service for our members.