To determine if pharmacy benefits are payable by Simply Healthcare Plans, Inc., please confirm the requested services are a covered benefit. Questions about members’ pharmacy benefits can be answered by calling our Pharmacy department at 877-577-9044 between 8 a.m. to 8 p.m. Eastern time, Monday through Friday.
Please refer to the Preferred Drug List (PDL) when prescribing for our members. This guide does not contain a complete list of drugs; rather, it lists the preferred drugs within the most commonly prescribed therapeutic categories.
Though most medications on the PDL are covered without precertification, a few agents will require you to contact our Pharmacy Department for authorization.
Ensure our members are equipped to renew their Medicaid Benefits
Help our members prepare to renew their Medicaid healthcare coverage and benefits by educating them on what documents are needed to ensure their renewal form is completed accurately. Members can submit their renewal form via web (preferred), phone, fax, mail, or in person.
For questions about eligibility, benefits, authorizations, claims status, and more; log in to Availity Essentials* and select Chat with Payer. For additional support, please use the following resources or contact us if more clarification is needed.
Florida Healthy Kids
Simply Healthcare Plans, Inc. (Simply) offers coverage to FHK-eligible children in all 11 regions of Florida, 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
Please refer to the Preferred Drug List (PDL) when prescribing for our members. This guide does not contain a complete list of drugs; rather, it lists the preferred drugs within the most commonly prescribed therapeutic categories.
Though most medications on the PDL are covered without precertification, a few agents will require you to contact our Pharmacy Department for authorization.
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Please visit the Availity portal.
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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.
Learning opportunities
Find learning opportunities to assist with administering your patient’s health plan using Availity Essentials multi-payer features and payer spaces applications. Use the library of self-paced courses and instructor-led training sessions, available 24/7 at no cost. Be prepared with the knowledge to assist our members.
At Availity, you can:
Request Authorizations.
Submit Claims.
Confirm Eligibility.
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Receive email from Simply
Simply is now sending some bulletins, policy change notifications, prior authorization update information, educational opportunities and more to providers via email.
Featured resources
Pharmacy Information
Search for up-to-date drug information, including hundreds of brand-name and generic medications.
Maternal Child Program
When it comes to our pregnant members, we are committed to keeping both mom and baby healthy. We encourage all our moms-to-be to take part in the Taking Care of Baby and Me® program, a comprehensive, proactive case management and care coordination program for all expectant mothers and their newborns.
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.
