PROVIDER UPDATE: In response to the temporary CHC service interruption, Simpra has contracted with Availity for claims submission. Continue to use codes SIM-01 and SIM-02. Contact your clearinghouse to determine if previously submitted claims need to be resubmitted.

Simpra Advantage PPO Plans

2023 Provider and Pharmacy Directory Introduction (Preamble)

This directory preamble is current as of October 2022.

This directory provides a list of Simpra Advantage’s current network providers for the state of Alabama.

To request a hard copy of Simpra Advantage’s provider directory, please call our Member Service Department at 1-844-637-4770, seven days a week (except Thanksgiving and Christmas) from October 1 through March 31 and Monday to Friday (except holidays) from April 1 through September 30. TTY users should call 1-833-312-0044. Simpra Advantage will mail a hard copy of the provider directory to you within three (3) business days of your request.  Simpra Advantage may ask whether your request for a hard copy is a one-time request or if you are requesting to receive the provider directory in hard copy permanently.

If you request it, your request for hard copies of the provider directory remains until you leave Simpra Advantage or request that hard copies be discontinued.

Statement of Nondiscrimination and Alternate Formats

Simpra Advantage complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

To request a directory in an alternate format like Large Print or in another language, call the Member Service Department at 1-844-637-4770. TTY users should call 1-833-312-0044.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-844-637-4770 (TTY 1-833-312-0044).

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-844-637-4770 (TTY 1-833-312-0044) 번으로 전화해 주십시오.

Introduction

This directory provides a list of Simpra Advantage’s network providers (doctors, hospitals, facilities, other services, or pharmacies).  To get detailed information about your health care coverage, please see your Evidence of Coverage (EOC).

You may choose one of our network providers listed in this directory to be your Primary Care Provider (PCP).  Generally, you must get your health care services from your PCP. Your PCP works in collaboration with your Simpra Advantage Nurse Practitioner to help assure you receive seamless, patient-centered care.

The network providers listed in this directory have agreed to provide you with your health care services.  You may go to any of our network providers listed in this directory; however, some services may require a referral. To obtain a referral, please contact your PCP or Nurse Practitioner.

Out-of-network providers are under no obligation to treat Simpra Advantage enrollees, except in emergencies.  For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service.  Please call our Member Service Department at 1-844-637-4770, seven days a week (except Thanksgiving and Christmas) from October 1 through March 31 and Monday to Friday (except holidays) from April 1 through September 30.  TTY users should call 1-833-312-0044. You may also visit Simpra.com to view your Evidence of Coverage (EOC) for more information, including the cost sharing that applies to out-of-network services.

Please note: If you receive a bill from an out-of-network provider, you should not pay the bill, unless you have received an Explanation of Benefits (EOB) from Simpra Advantage that details what the plan will pay for your service, and any remaining balance you need to pay. The out-of-network provider may also bill you for any remaining balance not paid by Simpra Advantage.

If you have already paid for the covered services, Simpra Advantage will reimburse you for our share of the cost, if prior approval is obtained. If you have any questions, visit Simpra.com or call Member Services at 1-844-637-4770. TTY users should call 1-833-312-0044.

Payment for services is contingent upon:

  1. The services you received are included in Simpra Advantage benefits as outlined in the Evidence of Coverage (EOC).
  2. The provider, or medical facility, you received services from is eligible for payment from Simpra Advantage.
  3. The service(s) meet requirement for medical necessity and authorization is obtained where necessary.

You may obtain emergency services from the closest available provider, and urgently needed services from any qualified provider when out of the plan’s service area or when network providers are unavailable. You may download guidelines for finding providers and pharmacies in an emergency situation for more information. Please be aware that with the exception of emergencies, it may cost more to get care from out-of-network providers.

What is the service area for Simpra Advantage?

The counties in our service area are listed below:

  • Autauga
  • Blount
  • Chambers
  • Clarke
  • Colbert
  • Crenshaw
  • DeKalb
  • Fayette
  • Hale
  • Jefferson
  • Lee
  • Madison
  • Mobile
  • Perry
  • Russell
  • Talladega
  • Washington
  • Baldwin
  • Bullock
  • Cherokee
  • Clay
  • Conecuh
  • Cullman
  • Elmore
  • Franklin
  • Henry
  • Lamar
  • Limestone
  • Marengo
  • Monroe
  • Pickens
  • Shelby
  • Tallapoosa
  • Wilcox
  • Barbour
  • Butler
  • Chilton
  • Cleburne
  • Coosa
  • Dale
  • Escambia
  • Geneva
  • Houston
  • Lauderdale
  • Lowndes
  • Marion
  • Montgomery
  • Pike
  • St. Clair
  • Tuscaloosa
  • Winston
  • Bibb
  • Calhoun
  • Choctaw
  • Coffee
  • Covington
  • Dallas
  • Etowah
  • Greene
  • Jackson
  • Lawrence
  • Macon
  • Marshall
  • Morgan
  • Randolph
  • Sumter
  • Walker
How do you find Simpra Advantage providers that serve your area? 

Step 1: Select the type of provider you are looking for, doctor/health care professional, or medical facility or pharmacy.

Step 2: Search by a specialty, name of provider, name of facility or pharmacy, or by the office location (city, state, or zip code).

You may get directions to the provider’s location or view the location on a map by clicking the image of the map on the right side of the provider’s information on the details page.

If you have questions about Simpra Advantage or require assistance in selecting a PCP, please call our Member Service Department at 1-844-637-4770 seven days a week (except Thanksgiving and Christmas) from October 1 through March 31 and Monday to Friday (except holidays) from April 1 through September 30. TTY users should call 1-833-312-0044.  Or you may visit Simpra.com.