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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 the secure portal?

For Medicaid services provided before the rollout of the new Statewide Medicaid Managed Care and Managed Medical Assistance contract or Medicare services providers before January 1, 2019, please visit the previous Simply provider portal.

For services provided after the new Medicaid and Medicare plan rollouts, please visit the Availity portal.

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

Need help with Availity? Learn more

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

Provider Manual Updates

To assist you in providing care to our members, the plan has updated its provider manual with valuable information on various subjects such as claim, authorization and, precertification. We invite you to review the most recent documentation located on our Provider websites for both Medicaid and Medicare products.

Medicaid Billing Requirements Effective 4/1/19

Beginning April 1, 2019, medical claims will be audited for Billing and Rendering Provider information. Claims will be rejected at the point of receipt if it is determined during claims validation that the Billing and/or Rendering providers on the claim are not enrolled or are inactive with Medicaid

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).

Medicare updates

Electronic claim payment reconsideration

As currently outlined in your provider manual, providers can submit claim payment reconsiderations verbally, in writing or electronically. We are reaching out to notify you about some exciting new tools for electronic submission that will become available through the Availity Portal. In addition, the Medicare Advantage provider manual has been updated with new information regarding claim remediation tools through the Availity Portal.
Beginning July 22, 2019, providers will have the ability to submit claim reconsideration requests through the Availity Portal with more robust functionality

Submitting corrected claims

Simply Healthcare Plans, Inc. will treat corrected claims as replacement claims. When you submit a corrected claim, it is important that you clearly identify that the claim is a correction rather than an original claim.

2019 provider trainings

The Simply Healthcare Plans, Inc. Medicare Risk Adjustment regulatory compliance team offers two provider training series regarding Medicare risk adjustment guidelines.

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.