Claims submission and disputes
Claims tools
Simply Healthcare Plans, Inc. uses Availity Essentials — a secure, full-service platform that offers a claims clearinghouse and real-time transactions at no charge to healthcare professionals. Use Availity Essentials to submit claims, check claims status, dispute a claim decision and much more.
Don’t have an Availity Essentials account?
Overpayment
Overpayment Refund/Remittance Payment should be mailed to our Atlanta address. Please include the project number and letter ID on your check.
Simply Healthcare Plans, Inc.
P.O. Box 933657
Atlanta, GA 31193-3657
Dispute overpayments
If you believe an overpayment has been identified in error, you may submit your dispute by fax to 866-920-1874 or mail to:
Simply Healthcare Plans, Inc.
Cost Containment Unit — Disputes
P.O. Box 62427
Virginia Beach, VA 23466-2437
If we do not receive payment or a dispute within 60 days, we will begin the process to offset the identified overpayment against future claims where contract terms and state law allow.
Finding claims tools on Availity Essentials
Submit claims:
- From the Availity Essentials homepage, select Claims & Payments from the top navigation.
- Select Claims & Encounters from the drop-down menu.
Claims status inquiry:
- From the Availity Essentials homepage, select Claims & Payments from the top navigation.
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Select Claims Status Inquiry from the drop-down menu.
Claims dispute:
To check claims status or dispute a claim:
- From the Availity Essentials homepage, select Claims & Payments from the top navigation.
- Select Claim Status Inquiry from the drop-down menu.
- Submit an inquiry and review the Claims Status Detail page.
- If the claim is denied or final, there will be an option to dispute the claim. Select Dispute the Claim to begin the process. You’ll be redirected to the Payer site to complete the submission.
Clear Claims Connection:
To use Clear Claims Connection:
- From the Availity Essentials homepage, select Payer Spaces from the top navigation.
- Select the appropriate health plan.
- From the Payer Spaces homepage, select the Applications tab.
- Select the Clear Claims Connection tile.