Simply Healthcare Provider Home


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.

At this time, enrollment for electronic funds transfer (EFT) through CAQH EnrollHub is unavailable. When this feature is available, we will provide an update.

Medicaid updates

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.

Payer ID Reminder

This notice serves to advise that effective November 20, 2019, Simply will no longer accept electronic claims submitted with a legacy payer ID.

Electronic Visit Verification (eVV) Effective December 1, 2019

Simply Healthcare Plans Inc. (Simply) is implementing an Electronic Visit Verification (EVV) system. Tellus eVV is a technology provider that collaborates with Simply. Starting December 1, 2019 all statewide Medicaid Managed Care Medical Assistance (SMMC MMA) services in Florida, including personal and home health services, must be submitted through the Tellus eVV system.

Please see here for more information:

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.*

Payer ID Reminder

This notice serves to advise that effective November 20, 2019, Simply will no longer accept electronic claims submitted with a legacy payer ID.

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.

New Medicare Beneficiary Identifier notice

CMS mailed out new Medicare cards without SSNs to offer better identity protection.

Providers can help protect their patients' identities by using the Medicare Beneficiary Identifier (MBI) for Medicare business, including claims submission and eligibility transactions.

For more information about this update, please visit this page.

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

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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.