Simply Healthcare Provider Home

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.

Florida Healthy Kids Award


Simply Healthcare Plans, Inc. (Simply) has officially been awarded a Florida Healthy Kids (FHK) statewide contract. Effective January 1, 2020, Simply will offer coverage to FHK-eligible children in all 11 regions, representing 67 counties.

FHK’s mission is to ensure the availability of child-centered health plans that provide comprehensive, quality health care services. The program has a subsidized plan for children ages 5 through the end of age 18 whose families exceed the income eligibility threshold for Medicaid, as well as full-pay options available for those who don’t qualify for subsidized coverage.

The FHK plan is designed specifically with kids in mind and provides children with access to the services they need at each unique stage of growth and development. Health services are delivered through our network of local doctors, specialists, hospitals, pharmacies and other health care providers.

Provider news


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

CAQH EnrollHub, which has been temporarily offline, will be operational on January 27, 2020.

Medicaid updates

Resources to support your diverse patient panel

Are you looking for innovative ways to improve your patients' health care experiences? Simply Healthcare Plans, Inc. and Clear Health Alliance have an online learning site called My Diverse Patients that offers insight on how to communicate with your diverse patient population. By completing the What Matters Most - Improving the Patient Experience course, you can obtain a Continuing Medical Education (CME) credit.

Housing Assistance Pilot Program for Statewide Medicaid Managed Care Managed Medical Assistance members

Simply Healthcare Plans (Simply) and Clear Health Alliance (CHA) are a part of the SMMC Housing Assistance Pilot Program. This program provides additional behavioral health services and supportive housing assistance services to eligible enrollees with severe mental illness (SMI) or substance abuse disorders (SUD). The program will specifically support enrollees who are homeless or at risk of homelessness due to their condition.

CLIA Provider Notification

Claims that are submitted for laboratory services subject to the Clinical Laboratory Improvement Amendments of 1988 (CLIA) statute and regulations require additional information to be considered for payment. To be considered for reimbursement of clinical laboratory services, a valid CLIA certificate identification number must be reported on a 1500 Health Insurance Claim Form (CMS-1500) beginning March 2, 2020.

Healthy Behaviors Rewards Program information

In accordance with the Florida Statute 409.973(3), as of October 1, 2014, all Medicaid managed care (MMC) plans must establish and maintain programs to encourage healthy behaviors. At a minimum, the MMC plans are expected to implement medically approved programs for smoking cessation, weight loss, and alcohol or substance use recovery. Simply Healthcare Plans, Inc. and Clear Health Alliance have developed three additional programs for asthma, maternity and well-child visits.

Medicare updates

Expansion of Specialty Pharmacy Precertification List: Zirabev

Effective March 23, 2020, the specialty Medicare Part B drug listed in the table below will be included in our precertification review process. Noncompliance with new requirements may result in denied claims.*

Pharmacy Benefit Manager Change to IngenioRx - Effective 1/1/2020

Earlier this year, Simply Healthcare Plans, Inc. announced the launch of IngenioRx, our new pharmacy benefits manager (PBM). Effective January 1, 2020, IngenioRx will start serving our members with Medicare Part D prescription drug coverage.

2020 Simply Rewards Program

The Simply Rewards Program is an incentive offered to all Simply Healthcare Medicare members beginning January 1, 2020. The goal of the program is to encourage members to obtain health care services that improve their wellbeing and health 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.

NCQA Health Plan Recognition


The National Committee for Quality Assurance has awarded an accreditation status of Accredited for service and clinical quality that meets the basic requirements of NCQA’s rigorous standards for consumer protection and quality improvement.

NCQA Health Plan Accreditation surveys include rigorous on-site and off-site evaluations of over 60 standards and selected HEDIS® measures. A team of physicians and health plan experts conducts accreditation surveys. A national oversight committee of physicians analyzes the team’s findings and assigns an accreditations level based on the performance of each plan being evaluated to NCQA’s standards.

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.