Precertification Requirements
Medical
Simply Healthcare Plans, Inc. (Simply) and Clear Health Alliance (CHA) highly encourage the submission of precertification requests via the Availity Portal.
All expedited service authorization requests must be submitted via the Availity* Portal. This will allow us to prioritize urgent service authorization requests appropriately, improve turnaround times, and reduce errors. Please do not send expedited service authorization requests via fax or phone call.
Standard precertification requests for Simply and CHA and Florida Healthy Kids can also be submitted via:
• Availity: https://www.availity.com
• Phone: 844-405-4296
• Fax: 800-964-3627
Standard precertification requests for Medicare Advantage can also be submitted via:
• Availity: https://www.availity.com
• Phone: 844-405-4297
• Fax: 800-959-1597
Behavioral Health
Beacon Phone Numbers for Members and Providers:
- 1-844-375-7215: Medicaid
- 1-855-861-2142: Florida Healthy Kids
- 1-877-698-7787: Medicare
- 1-786-837-2850 :Providers wanting to join Beacon Network
Preauthorizations:
- 1-800-221-5487: IP, IOP, PHP, SIPP, RTC
- 1-844-375-7215: OP Medicaid
- 1-855-861-2142: FHK
Beacon Fax Numbers:
- IP, IOP, PHP, SIPP, RTC Preauthorization: We do not accept faxes for this LOC, only phone calls.
- 1-800-370-1116: Medicare Preauthorization
- 1-800-370-1116: Medicaid Outpatient Preauthorization
Join Network for Providers
- 1-786-837-2850
Crisis Calls for Members
- 1-844-375-7215, Press 9, Press 1 for English or 2 for Spanish, Press 9 for Emergency, will then be transferred to a clinician
Pharmacy
Check our preferred drug list
Services billed with the following revenue codes ALWAYS require precertification:
0632 — Pharmacy multiple sources
Medicare
Precertification is not required for physician E&M services for members of the Medicare Advantage Classic plan.
Long-Term Services and Supports
Providers needing an authorization should call 1-877-440-3738.
The following ALWAYS require precertification:
Elective services provided by or arranged at nonparticipating facilities
All services billed with the following revenue codes:
0023 — Home health prospective payment system
0570–0572, 0579 — Home health aide
0944–0945 — Other therapeutic services
3101–3109 — Adult day and foster care
Precertification Tool
To request or check the status of a precertification request or decision, please login to Availity.