Simply Healthcare Medicaid Managed Care Provider Bulletin
This file contains important updates regarding Simply Healthcare Plans and Medicaid Managed Care details for providers. It includes information on claims submissions and authorizations effective from May 1, 2021. Providers and subcontractors should refer to this file for guidelines on care continuity and payment processes.
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How do I fill this out?
Filling out this form involves understanding the necessary details for claims and authorizations. Ensure you have all required information ready before initiating the process. Follow the outlined steps for submitting your claims accurately.
How to fill out the Simply Healthcare Medicaid Managed Care Provider Bulletin?
1
Collect necessary provider information and patient details.
2
Determine the type of claims being submitted (pre or post go-live).
3
Fill out the required fields accurately.
4
Submit claims electronically or by mail as per the guidelines.
5
Keep a copy of all submissions for your records.
Who needs the Simply Healthcare Medicaid Managed Care Provider Bulletin?
1
Healthcare providers who need to submit claims to Simply Healthcare.
2
Medicaid recipients who require clarity on coverage.
3
Insurance agents assisting clients with Medicaid.
4
Medical billing departments requiring updated submission protocols.
5
Social workers guiding patients through the claims process.
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What are the instructions for submitting this form?
For submitting claims, providers may choose to send them electronically through the specified portal or by mail. Paper claims should be sent to Simply Healthcare Plans, Inc. at P.O. Box 61010, Virginia Beach, VA 23466-1010 or to the relevant department within Miami Children's Health Plan for previous dates. For any inquiries regarding submissions, contact Provider Services at 1-844-405-4296 or refer to the instructions outlined in this file.
What are the important dates for this form in 2024 and 2025?
The crucial dates for this form include the effective date of claims processed from May 1, 2021. It's important to pay attention to any additional deadlines set for 2024 and 2025 for claims submissions and authorizations.
What is the purpose of this form?
The purpose of this form is to provide healthcare providers with vital information regarding claims submissions and authorizations. It outlines procedures for seamless transitions from Miami Children's Health Plan to Simply Healthcare. This document ensures that all stakeholders are informed about their roles and responsibilities within the Medicaid Managed Care framework.
Tell me about this form and its components and fields line-by-line.
- 1. Provider Details: Contains information about the healthcare provider including name and contact.
- 2. Claim Type: Specifies whether the claim is for services before or after the effective date.
- 3. Patient Information: Includes details about the patient receiving services.
- 4. Services Rendered: Details the types of services provided to the patient.
- 5. Authorization Number: Required authorization numbers for services.
What happens if I fail to submit this form?
Failing to submit this form can result in delayed payments or denials of claims. Ensuring timely and accurate submission is crucial for receiving reimbursements.
- Delayed Processing: Claims may take longer to process if not submitted correctly.
- Denial of Claims: Inaccurate or incomplete submissions can lead to claim denials.
- Financial Impact: Delays or denials may impact the financial situation of providers.
How do I know when to use this form?
- 1. New Patient Claims: Utilize this form for submitting claims for new patients enrolled on or after the effective date.
- 2. Transitional Claims: Applicable for claims that span the transition from Miami Children's Health Plan.
- 3. Routine Claims: Use for ongoing treatments and routine claims submissions.
Frequently Asked Questions
How can I submit my claims using this file?
Submit your claims electronically through our specified online portal or via mail as outlined in the document.
What should I do if I encounter issues with submissions?
Contact the Provider Services for assistance or refer to the relevant contact numbers provided in the document.
Is there a deadline for submitting claims?
Yes, claims must be submitted by the specified deadlines to ensure timely processing.
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Yes, PrintFriendly allows you to edit PDF forms easily before downloading them.
How can I sign my PDF document?
You can add your signature digitally within the PrintFriendly platform.
Is there assistance available for using this form?
Provider Relations representatives are available during business hours to assist with any questions.
What types of claims can I submit with this form?
This form is for submitting claims related to Simply Healthcare and Miami Children's Health Plan services.
How do I keep track of my submissions?
It is recommended to maintain copies of your submissions for your records.
Who can benefit from this file?
Healthcare providers, Medicaid recipients, and insurance agents can all benefit from the information in this file.
Are there specific requirements for filling this form?
Yes, the form requires specific information about services rendered and must be completed accurately for processing.
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