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.
Medicaid/Florida Healthy Kids updates
Simply Medicaid Acquisition Regions 1 and 2
- Simply is acquiring the SMMC MMA contract from Lighthouse Health Plan effective February 1, 2021. This acquisition expands the Medicaid footprint of Simply in regions 1 and 2 as a non-specialty SMMC MMA plan.
Simply Healthcare Plans, Inc. Vision Services Vendor Transition to iCare Health Solutions, LLC
Effective December 31, 2020, EyeQuest (DentaQuest of Florida, Inc.) will no longer be providing medical and surgical vision services for Simply Healthcare Plans, Inc. (Simply) members. Beginning January 1, 2021, iCare Health Solutions, LLC will be the statewide subcontractor providing medical and surgical vision services to Simply members.
Important laboratory reminder
LabCorp is the exclusive independent laboratory provider for Simply and Clear Health Alliance.
New prior authorization requirements for outpatient procedures
Effective January 1, 2021, prior authorization (PA) requirements will be required for the CPT codes listed in this provider bulletin.
Updates to AIM Clinical Appropriateness Guidelines for Advanced Imaging
Updates to the AIM Clinical Appropriateness Guidelines for Advanced Imaging for claims with dates of service on and after March 14, 2021.
Prior authorization requirement for outpatient procedures if done in the outpatient hospital setting (place of service 22/billing code 013)
Effective January 1, 2021, prior authorization requirements will be required for the following CPT codes if requested in the outpatient (OP) hospital setting.
Medicare updates
Medicare Advantage — PN for UM AROW Item 1330
On April 1, 2021, Simply Healthcare Plans, Inc. prior authorization requirements will change for the following codes.
Racial Trauma Forum Invitation
Please join us to hear from a diverse panel of experienced Motivo* and Simply Healthcare Plans, Inc. professionals on addressing racial trauma with your patients as well as navigating our experiences and perspectives, ensuring culturally competent care and self-care.
Mind, Body, Magic Launches on YouTube
We’re thrilled to announce the launch of our new healthy-living series, Mind, Body, Magic! Hosted by NBA Hall of Famer and our very own Healthcare Advocate, Earvin “Magic” Johnson, the series provides viewers with the information they need to be more confident in managing their health. Over the course of four episodes, Johnson talks with experts from across our state, and country, about a holistic approach to our well-being. Check out the Mind, Body, Magic series on YouTube.
Legacy Provider Portal Update
Simply Healthcare Plans, Inc. and Clear Health Alliance (Simply) are currently undergoing a Legacy Provider Portal upgrade that will affect users who use the URL to review claims with dates of service from 2018 and prior to 2018.
HealthCrowd Text Messaging
Simply Healthcare Plans, Inc. (Simply) and Clear Health Alliance (CHA) are working with HealthCrowd* to reach out to members using text messaging. These messages will provide reminders when chronic condition services and preventive services are due. The messages will also provide education about self-management.
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
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!
Featured resources
Pharmacy Information
Search for up-to-date drug information, including hundreds of brand-name and generic medications.
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.
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.
