Provider Resources
Tools and information to help improve the provider experience and member health outcomes
eHealthsuite™
Eligibility & Claims portal
ACUITYNxt™
Prior Authorization Portal
Provider Directory Maintenance with Members in Mind
There’s never been a more important time to confirm the accuracy of your Simpra Advantage Provider Directory information. Accurate information helps our members find you and supports your compliance with CMS Medicare Advantage (MA) requirements for maintaining current and reliable provider directory data.
To support your compliance with CMS Medicare Advantage provider directory accuracy requirements, Simpra Advantage conducts routine outreach to verify and update provider information. CMS requires MA organizations to maintain accurate, up-to-date provider directory data and to implement a process for regular verification and timely corrections.
- To help maintain compliance, you will be contacted every 90 days to visit the Quest Analytics BetterDoctor® online portal to make attestations and corrections. Click here for more information.
- To help ensure our members have up-to-date information, you may notify Simpra Network Support of a change to your information any time, and preferably no later than 30 days prior to an upcoming change. Click here to access the Provider Directory Maintenance Form.
Join Our Network
Start here to become a provider in the Simpra Advantage network.
Update Provider Information
Make it easy for members to find you.
Claims
Everything you need to know about our Electronic Claims Submission process.
Clinical Practice Guidelines and Medical Necessity
Our guidelines to ensure you have the most up-to-date, evidence-based information.
For Prescribers and Pharmacies
Find formularies, prior
authorization criteria, step therapy
criteria, and more.
Provider Documents
Access important plan information,
provider portal, processes, and
directories.
Find A Drug
Access important plan information,
provider portal, processes, and
directories.
About the Provider Portal
Secure access to claims, eligibility info, authorizations, password resets, and more.