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Medicaid Reference Guide
SFLPEC-1678-19
Vendor informationSimply Healthcare Plans, Inc. (Simply) and Clear Health Alliance (CHA) provides services for members enrolled in Statewide Medicaid Managed Care Managed Medical Assistance (SMMC MMA) and Statewide Medicaid Managed Care Long-Term Care (SMMC LTC). Simply and CHA collaborate with vendors who provide services for our members. Contact information for these vendors is below.
Service Vendor Contact information
Hearing services 20/20 Hearing Care Network, Inc. 1-877-727-4077
Radiology authorization AIM Specialty Health® 1-800-714-0040
Behavioral healthBeacon Health (behavioral health services)
1-844-375-7215
Chiropractic services Chiro Alliance Corporation 1-877-434-8258
Pharmacy benefit manager IngenioRX 1-844-405-4296
Routine vision EyeQuest 1-844-870-3979
Home delivered meals, postfacility discharge
GA Foods 1-866-575-2772
Dermatology Health Network One (HN1) 1-800-595-9631
PT/OT/ST therapy Health Network One (HN1) 1-888-550-8800
Home health care, durable medical equipment (DME) and home IV infusion
Integrated Home Care Services (IHCS) 1-844-215-4264
Laboratory services LabCorp 1-800-877-5227
Claims submissionsPaper claims Electronic claims
Simply Healthcare Plans, Inc.P.O. Box 61010Virginia Beach, VA 23466-1010
Availity Payer ID • Simply: SMPLY• CHA: CLEAR
Availity• Claim submission• Claim status• Member eligibility• EDI• Reports• Electronic prior authorization requests and checking for authorization rules• Claims dispute
Visit https://www.availity.com.
Claims dispute processVerbal dispute Written dispute
1-844-405-4296 Simply Healthcare Plans, Inc.Payment AppealsP.O. Box 61599Virginia Beach, VA 23466-1599
Visit our websites for more information:• www.simplyhealthcareplans.com/provider• www.clearhealthalliance.com/provider
To check authorization requirements, visit https://www.simplyhealthcareplans.com/florida-provider/precertification-lookup.
Authorizations
Online Interactive Care Reviewer: https://www.availity.com
Phone 1-844-405-4296
Fax 1-800-964-3627
The following data is required for complete notification/precertification:• Member ID• Legible name of referring provider• Legible name of individual referred to provider• National provider identifier and/or tax ID number• Number of visits/services• Date(s) of service• Diagnosis• CPT®/HCPCS codes
Provider ServicesPhone: 1-844-405-4296
Provider manager information:
Name
Phone
To reach the SMMC LTC Provider Services team, call 1-877-440-3738.
Simply Healthcare Plans, Inc. is a Managed Care Plan with a Florida Medicaid contract. Clear Health Alliance is a Managed Care Plan with a Florida Medicaid contract. IngenioRx, Inc. is an independent company providing pharmacy benefit management services on behalf of Simply Healthcare Plans, Inc. AIM Specialty Health is a separate company providing utilization review services on behalf of Simply Healthcare Plans, Inc. and Clear Health Alliance.
https://provider.simplyhealthcareplans.com/florida-provider
www.clearhealthalliance.com/provider
Member transportation
Vendor LogistiCare
(LGTC)
Midwest Coast Transport, Inc.
(MCT)
Servicing regions
1 to 9 10 and 11
Contact 1-866-779-5235 1-844-628-0388 1-877-671-6671
ProductSimply and
CHASimply only CHA only
Member Services and 24/7 NurseLineSMMC MMA 1-844-406-2396
SMMC LTC 1-877-440-3738
CHA 1-844-406-2398
Electronic funds transfer (EFT) enrollment
Use the Council for Affordable Quality Healthcare electronic funds transfer (CAQH EFT) EnrollHub tool, available at https://www.caqh.org/solutions/enrollhub.
CAQH Provider Help Desk: • 1-844-815-9763• 7 a.m. to 9 p.m. ET, Monday
through Thursday• 7 a.m. to 7 p.m. ET, Friday
Electronic remittance advice (ERA) enrollmentGo to https://www.availity.com, log in and select Enrollments Center in the My Account Dashboard. Select ERA Enrollment in the Multi-Payer Enrollments section. Then, simply follow the wizard and submit. After submitting, you will be notified by email that enrollment is complete and start receiving 835s through Availity.
Availity 1-800-282-4548
Electronic Data Interchange (EDI) HelpDesk
1-800-590-5745SUB
Key community contacts
Vaccines for Children (for SMMC MMA only)
1-800-483-2543
Immunization Registry (SHOTS)
1-877-888-SHOT (1-877-888-7468)
It’s Great to Wait Pregnancy Prevention Program
1-866-232-3309
Healthy Start Program
1-800-541-BABY (toll free)
1-386-758-1135 (or the local health department)
Women, Infants, and Children and Nutritional Service
1-800-342-3556
Florida Quitline (smoking cessation)
1-877-U-CAN-NOW (1-877-822-6669)
SMMC LTC enrollmentPhone:• 1-877-711-3662, TDD: 1-866-467-4970• Monday through Thursday: 8 a.m. to
8 p.m. ET• Friday: 8 a.m. to 7 p.m. ET
