Provider Digital Engagement Supplement Guidelines for Simply Healthcare Plans
This file is a supplement that establishes standards for using secure digital provider tools and applications. It's applicable to Simply Healthcare Plans, Inc. and Clear Health Alliance (CHA) for commercial and government business divisions. The file includes information about digital tools, transaction methods, and process changes.
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How do I fill this out?
To fill out this form, start by reading the instructions carefully to understand the requirements. Gather all necessary information and documentation beforehand. Follow the step-by-step guide provided below to complete each section accurately.
How to fill out the Provider Digital Engagement Supplement Guidelines for Simply Healthcare Plans?
1
Read the instructions carefully to understand the requirements.
2
Gather all necessary information and documentation.
3
Access the Availity Provider Portal for digital tools.
4
Complete each section accurately as per the guidelines.
5
Submit the form using the specified submission method.
Who needs the Provider Digital Engagement Supplement Guidelines for Simply Healthcare Plans?
1
Healthcare providers who need to use digital tools for provider-patient interactions.
2
Administrators who manage the transactional processes for healthcare services.
3
IT personnel integrating B2B API for healthcare services.
4
Providers handling claims and remittances.
5
Any health professionals required to access and use digital ID cards.
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What are the instructions for submitting this form?
To submit this form, use the secure Availity Provider Portal at https://www.availity.com. For electronic submissions, ensure all required fields are completed accurately. Physical submissions should be mailed to Simply Healthcare Plans, Inc. at their provided address. For any questions or assistance, contact their support via email or phone number listed on the portal. My advice is to use electronic submission methods for faster processing and confirmation.
What are the important dates for this form in 2024 and 2025?
Key dates for 2024 and 2025 will depend on updates from Simply Healthcare Plans and CHA. Ensure you stay updated with any notifications provided by these organizations regarding the use of digital tools and submission deadlines.
What is the purpose of this form?
The purpose of this supplement is to establish standards for using secure digital provider tools and applications. It aims to increase efficiency for both participating and nonparticipating providers by outlining the use of electronic channels for various transactions. This supplement ensures healthcare providers can access necessary digital resources and submit required information securely.
Tell me about this form and its components and fields line-by-line.
- 1. Transaction Methods: Different methods including manual, partial, and electronic transactions with time comparisons.
- 2. Digital Tools Usage: Guidelines for acceptance of digital ID cards, eligibility inquiries, and prior authorization processes.
- 3. Claim Management: Instructions for claim submissions, attachments, and status inquiries using electronic methods.
- 4. Provider Portal Access: Details on accessing and using the Availity Provider Portal for various self-service tools.
- 5. EDI Transactions: Information on electronic data interchange transactions and gateway usage.
What happens if I fail to submit this form?
Failing to submit the form may result in delays in processing and accessing digital tools. It could impact transaction efficiency and compliance with specified standards.
- Processing Delays: Submission delays can affect transaction handling and claim processing.
- Compliance Issues: Non-compliance with guidelines may result in administrative consequences and standard deviations.
How do I know when to use this form?
- 1. Eligibility Inquiries: When verifying eligibility and benefits for patients.
- 2. Prior Authorizations: For submitting and managing prior authorization requests.
- 3. Claim Submissions: When submitting and tracking medical claims and their statuses.
- 4. Remittances: For receiving and managing payment remittances electronically.
- 5. Provider Enrollment: When enrolling as a provider with Simply and CHA.
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