Claims Submission
Filing your claims should be simple. That’s why Simply Healthcare Plans, Inc. uses Availity, a secure and full-service web portal that offers a claims clearinghouse and real-time transactions at no charge to health care professionals. You can use Availity to submit and check the status of all your claims and much more at www.availity.com .
Don’t have an Availity account? You can register for free.
Claims payment exceptions process — Hurricane Ian
Simply Healthcare Plans, Inc. has implemented a claims payment exceptions process for the reimbursement of services provided in good faith to eligible Florida Medicaid recipients in FEMA designated counties during the disaster grace period. The Agency for Health Care Administration defines the disaster grace period for Hurricane Ian as September 29, 2022, through November 30, 2022. This claims payment exceptions process includes services that:
- Normally would have required a prior authorization.
- Were rendered by a non-participating or out-of-state provider without a Florida Medicaid provider number.
- Exceeded coverage limits.
Providers who wish to receive payment for services rendered during and outside of the disaster grace period are required to be enrolled with Florida Medicaid or provisionally enrolled with Florida Medicaid prior to submitting claims. For instructions and further guidance on provisional enrollment and the claims payment exceptions process, select here .
More resources
EDI
Electronic data interchange (EDI) is the computer-to-computer exchange of business documents in a structured format. EDI provides a faster and cleaner method for delivering time-dependent data, saving you time compared to filing paper claims.
Provider disputes
You have the right to dispute a claim decision. You may request this dispute on your own behalf or on behalf of a covered Individual.