Provider manuals and guides
Simply Healthcare Plans, Inc. (Simply) is committed to supporting you in providing quality care and services to the members in our network. Here you will find information for assessing coverage options, guidelines for clinical utilization management (UM), practice policies and support for delivering benefits to our members.
Provider manual
Simply’s provider manual provides key administrative information, including the quality improvement program, the UM program, quality standards for participation, claims appeals, and reimbursement and administration policies.
Additional Resources
Medical Policies and Clinical UM Guidelines
Medical policy addresses the medical necessity of new services or procedures and new applications of existing services or procedures. Clinical UM Guidelines focus on detailed selection criteria, goal length of stay, and location for generally accepted technologies or services.
Medicare Providers, improve your prior authorization and claims submission process. Our new online Clinical Documentation Lookup Tool (CDLT) gives real-time access to the highly recommended medical documents needed with submission.
Access the Clinical Documentation Lookup Tool
- 2025 Clinical Practice Guidelines
- Introducing a new clinical criteria web page
- Member Preventive Health Care Guidelines
- November 2024 Clinical Utilization Management Guidelines
- FHK - November 2024 Clinical Utilization Management Guidelines
- FHK - February 2025 Clinical Utilization Management Guidelines
- February 2025 Clinical Utilization Management Guidelines
- FHK - May 2025 Clinical Utilization Management Guidelines
- May 2025 Clinical Utilization Management Guidelines
- August 2025 Clinical Utilization Management Guidelines
- FHK - August 2025 Clinical Utilization Management Guidelines