VOLUME 4. Table of Contents

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1 Table of Contents Happy Thanksgiving... 1 Credentialing Reminder... 1 Pre-Certification Fax Number Changes... 2 Medicaid New Medicaid Vendors... 3 Florida Healthy Kids... 4 Florida Healthy Kids Eligibility & Enrollment... 4 Long Term Care... 4 Monthly Provider Training... 4 We Are Re-Branding... 5 Medicare Important Dates... 5 New Claims Processes Operational Changes What is Changing?... 9 What Changed?... 9 Happy Thanksgiving Thanksgiving evokes the spirit of giving thanks and joy. Simply Healthcare wants to thank you for your hard work day in and day out to serve our members and aiding in providing the best quality of care possible. Thank you for your dedication, your willingness to go above and beyond not only in the care of members but also with your commitment to our plan. From our Simply family to yours, Happy Thanksgiving! Credentialing Reminder Over the last few months, our Credentialing process has received a reboot. Upon submitting a credentialing application, here are some helpful tips to avoid delays and expedite the process: Ensure the providers CAQH attestation is current and updated quarterly All required Credentials are current and attached under the supporting document section (License, DEA and Malpractice, etc.) Verify Medicaid and Medicare ID numbers are listed on CAQH Board certification status should be noted and any copies of current Certificates attached Update all Practice and work history information listed under CAQH Hospital privileges section should be completed and list percentage of admissions. If no Admitting privileges provider should use CAQH supplemental data sheet and name the admitting physician or Hospitalist group. Provide a current Credentialing contact person in the event that further documentation is required to complete the packet. Simply Healthcare aims to make the provider experience as smooth as possible. If you have further questions, please contact your assigned Network Manager or contact our Provider Services Department Phone: or Info@simplyhealthcareplans.com. PAGE 1 OF 9

2 Pre-Certification Fax Number Changes Utilization Management Authorization request FAX numbers are changing for Simply Medicare, Simply Medicaid, Clear Health Alliance, Florida Healthy Kids, and Long Term Care. SIMPLY HEALTHCARE The chart below will provide guidance when faxing a request for authorization to the plan. RETIRED Fax Numbers NEW Fax Numbers Effective Dates Utilization Management Number Outpatient Clinicals South Florida Outpatient Clinicals South Florida Ancillary Team (DME/HH) Hospital Discharges South Florida Admission Notification / Internet Authorization Requests South Florida Concurrent Review MEDICARE Pharmacy Injectables Request MEDICAID Pharmacy Injectables Request December 1, 2018 Medicaid Products in Regions 9, 10 & 11 January 1, 2019 Medicaid Products in Regions 5,6,7 & 8 Medicare Products Statewide February 1, 2019 Medicaid Products in Regions 1,2,3 & 4 How to Stay Informed For AHCA s SMMC Medicaid Provider Alerts: Sign up online at: For important instructions on enrollment and payment on services rendered during the Hurricane Michael Disaster, please visit providers/provider-communications. Simply Healthcare Plans will continue to provide guidance. Missed the last Provider Bulletin? View previous publications at PAGE 2 OF 9

3 Medicaid New Medicaid Vendors As we continue to work to provide the best access to care to our Medicaid members in Florida, we are making changes to our vendors and proud to announce our new partnerships. Based on the regional rollout below is a glimpse into our new vendors for Simply Medicaid and Clear Health Alliance. 20/20 Hearing Network Inc. AIM Specialty Health New Premier Hearing care network committed to providing comprehensive, superior hearing benefits throughout the state of Florida. The AIM Radiology Solution is a radiology benefits management program that manages advanced imaging services and controls their escalating costs. Leading the industry for more than 25 years AIM solutions ensure clinically appropriate, affordable advanced imaging studies through evidence-based guidelines, practice trends reporting, and member engagement. EyeQuest Since its launch in 2008, EyeQuest has earned a reputation as a dependable partner for health plans seeking a practical solution for vision program management. Today, EyeQuest provides comprehensive eye care coverage to over 1.5 million members across the country. EyeQuest delivers exceptional value to its clients through the provision of strong provider networks, flexible plan designs, and superior technology. Their singular focus is to provide providers with integrated, high quality, easy to implement solutions that improve the eye health of members while reducing health care costs. Integrated Home Care Services IHCS provides an Integrated Delivery System for Durable Medical Equipment (DME) to the member s home setting. IHCS also offers accredited providers to respond to the needs of members - 24 hours a day - 7 days a week. LabCorp LabCorp provides comprehensive clinical laboratory by delivering world-class diagnostics solution and using technology to improve the delivery of care to globally. PAGE 3 OF 9

4 Florida Healthy Kids The Florida Healthy Kids Corporation was created in 1990 by the Florida Legislature as a public-private effort to improve access to health insurance for the state s uninsured children. As of December 1, 2018 our Childrens Health Insurance Program known today as Amerigroup Florida Health Kids in regions 6,7,10 and 11 will be rebranded and become known as Simply Florida Healthy Kids (FHK). Florida Healthy Kids Eligibility and Enrollment A family that does not get Medicaid may still get health care for their child(ren) through Florida Healthy Kids. There are income guidelines. To be eligible for Florida Healthy Kids, a child: Must be 5-18 years old Is a U.S. citizen or qualified noncitizen Must not be eligible for Medicaid and Must not have health coverage You can apply: Online at Florida Healthy Kids. Call Florida Healthy Kids at KIDS (5437). Long Term Care Our Long Term Care team is focused on helping our members stay in their home by providing services such as adult day care, personal care or homemaker services in their home or paying for care in an assisted living facility. If you have a member that is interested in enrolling or would like additional information they can speak with a choice counselor via phone at Monday Thursday, 8:00am to 8:00pm and Friday 8:00am 7:00pm TDD users ONLY call Monthly Provider Training If you haven t done so already, remember to register to our provider webinar trainings. These trainings will answer your questions regarding members who are enrolled in SMMC MMA and LTC. *** UPCOMING WEBINAR TRAINING *** November 20, 2018 at 10:00AM EST. Registration Link: Visit our website for future training dates and times. PAGE 4 OF 9

5 LTHCARE A E H Y L P SIM R E D I V O PR BULLETIVN OLUME 4 We Are Re-Branding Remember! Amerigroup Florida and Better Health will become Simply Healthcare. Same doctors, same benefits, same plan. Simply a new name. Visit our website our plan websites for further information. Medicare Important Dates October 15 - December 7, 2018 AEP - Annual Election Period. Members can change their Medicare health or prescription drug coverage for an effective date of January 1, 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. PAGE 5 OF 9

6 Submitting Medicare Advantage Claims, Correspondence, Appeals, Claim Reviews and Disputes Dates of service through December 31, 2018 Continue to use the established submission process. If you need further details on the current submission process please visit our website at Dates of Service January 1, Forward Paper Claims o PO Box 61010, Virginia Beach, VA Provider Correspondence and Provider Payment Disputes, o P.O. Box Virginia Beach, VA Electronic Claims Payer ID o Availity Payer ID: SMPLY Medicare Complaints, Appeals & Grievances (MCAG) Attention: Medical Necessity Provider Appeals Mailstop: OH0205-A Irwin Simpson Road Mason, Ohio Claims for dates of service that span 2018 and 2019 calendar years require two (2) claims to be submitted as noted in the example below: Example: Actual Dates of Service: December 28, 2018 through January 2, 2019: Submit a claim for: o Dates of Service December 28, 2018 through December 31, 2018 using existing submission methods. o Dates of Service January 1, 2019 through January 2, 2019 using the new submission information provided above. *Note: Please submit claims with dates of services using calendar year format. Inpatient UB04 claims are excluded from this process. PAGE 6 OF 9

7 Simply Healthcare Medicare Advantage Member ID information To help ensure timely and accurately processing, it is important to submit claims with the correct Member Identification number. Simply Medicare Advantage members will be given a new member ID card for dates of services January 1, forward. Please DO NOT use this card prior to January 1, Member ID numbers will change for dates of service beginning January 1, Providers must submit claims with the correct member ID. To differentiate the old and new cards: New claims system (dates of services January 1, forward) Member ID will be 3 numbers, then an M (4th digit), then 5 numbers. Example: 123M45678 Effective date will indicate calendar year Old claims system (dates of services through December 31, 2018) Member ID starts with MC, followed by 8 numbers. Example: MC Effective date will NOT indicate calendar year 2019 (2018 and prior would indicated). Provider Services Phone Number Change Existing Simply Provider Services Phone Numbers New Simply Provider Services Phone Number Starting 01/01/ Enrollment status: select 1 Claims status: select 2 Prior authorizations: select 3 Other inquiries: select 4 Provider Services representatives are available to answer calls from 8 a.m. to 7 p.m. ET, Monday through Friday. Member eligibility, prior authorizations and claims payment information is available 24/7 at PAGE 7 OF 9

8 Electronic Data Interchange (EDI) Effective December 1, 2018 Availity will serve as your EDI partner for all electronic data and transactions. Most of you know Availity as web portal or claims clearinghouse, but it is much more. Availity is also an intelligent EDI Gateway for multiple payers, and will be the single EDI connection for Simply Healthcare, Inc. Your organization can submit and receive the following transactions through Availity s EDI Gateway: 837- Institutional Claims 835- Electronic Remittance Advice 837- Professional Claims 276/277- Claim Status 837- Dental Claims 270/271- Eligibility Request Get Started with Availity If you wish to continue using your clearinghouse, please work with them to ensure connectivity; otherwise, no action is necessary on your part. If you wish to submit directly, the Availity setup is easy. Use the Welcome Application link below to begin the process of connecting to the Availity EDI Gateway for your EDI transmissions. Payer ID for EDI Transmissions to Availity Dates of service prior to January 1st Dates of Service January 1st 2019 SMPLY Electronic Funds Transfer (EFT) Registration To register or manage account changes for EFT only, use the EnrollHub, a CAQH Solutions enrollment tool, a secure electronic EFT registration platform. This tool eliminates the need for paper registration, reduces administrative time and costs and allows you to register with multiple payers at one time. If you were previously registered to receive EFT only, you must register using EnrollHub to manage account changes. No other action is needed. PAGE 8 OF 9

9 Electronic Remittance Advice (ERA) Registration Please use Availity to register and manage account changes for ERA. Suppress (turn off) paper remittance vouchers: Contacting Availity If you have any questions please contact Availity Client Services at Availity ( ) Monday through Friday 8 a.m. to 7:30 p.m. Eastern Time Operational Changes What is Changing? Effective Dec. 1, 2018, LabCorp will replace Quest Diagnostics as our laboratory vendor for all plans Medicaid, Medicare and Long-Term Care with Simply Healthcare Plans, Inc. (Simply) and Clear Health Alliance. Effective Dec. 1, 2018, the Medicaid Provider Services phone number is changing to Effective Jan. 1, 2019, the new Medicare Advantage Provider Services phone number is What Changed? Effective July 1, 2018, HN1 is providing physical, occupational and speech therapy management on behalf of Simply for Medicaid and Medicare members. HN1 participating therapists will render these specialty services as we look to continue to improve and facilitate member experience. If you would like to contact a network representative from HN1, contact , Option 2 or visit for more information. PAGE 9 OF 9