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Providers

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.

Looking for access to Simply’s legacy portal?

Need help regarding services rendered prior to the health plan’s transition to Availity?

For Medicaid transactions prior to rollout of the new Statewide Medicaid Managed Care Managed Medical Assistance contract, please visit the previous provider portal.

For Medicare member eligibility and benefits lookup before January 1, 2019, please visit the previous provider portal.

Launch Availity
Precertification
Claims & Appeals
Forms
Education & Training

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 updates

Looking for previous records?

Need help regarding services rendered prior to the health plan’s transition to the new provider website or services rendered prior to the health plan’s transition to Availity? Visit the previous provider portal

Medicaid Billing Requirements Effective 4/1/19

Beginning April 1, 2019, medical claims will be audited for Billing and Rendering Provider information. Claims will be rejected at the point of receipt if it is determined during claims validation that the Billing and/or Rendering providers on the claim are not enrolled or are inactive with Medicaid

GA Foods Agreement Announcement

Simply Healthcare Plans, Inc. and Clear Health Alliance (Simply) has entered into an agreement with GA Foods for the distribution of post discharge and chronic meals.

Simply Healthcare Plans, Inc. and Clear Health Alliance EIS and TCM Continuity of Care Processes

This notice serves to provide information to Early Intervention Services (EIS) and Children’s Health Targeted Case Management (TCM) providers concerning Statewide Medicaid Managed Care Managed Medical Assistance (SMMC MMA) continuity of care (COC) requirements for new members who transition into Simply Healthcare Plans, Inc. and Clear Health Alliance (Simply).

Medicare updates

Pharmacy and Therapeutic Committee updates

On August 17, 2018 and November 16, 2018, the Pharmacy and Therapeutic Committee approved the following Pharmacy Policies applicable to Simply. These policies were developed, revised or reviewed to support clinical coding edits.

GA Foods Agreement Announcement

Simply Healthcare Plans, Inc. and Clear Health Alliance (Simply) has entered into an agreement with GA Foods for the distribution of post discharge and chronic meals.

Medicare Advantage claims and correspondence information

Effective for dates of service January 1, 2019 and after, Simply Healthcare Plans Inc. Medicare Advantage claims will transition to a new claims system. This will change the way that claims, correspondence, appeals, claim reviews and disputes are submitted to Simply. The following information will help you ensure that your Medicare Advantage claims are processed accurately.

Provider offices are crucial to Medicare CAHPS and HOS survey performance

Each spring, some of your patients are asked to complete a CAHPS® or HOS survey. These surveys are an important tool to help us monitor how our members think we are doing. The results of these surveys are available to the public on the Medicare Plan Finder website and have a direct impact on the plan’s Star rating. It is important to remember that our performance on these surveys is based on patients’ perceptions, not clinical outcomes.

 

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.

Provider survey

We want to hear from you! Please help us improve our provider website by taking this brief survey.

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.

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