Providers & Partners

The first thing physicians discover about Simpra Advantage is that we aren’t just another Medicare Advantage health plan. We have a different philosophy, attitude and approach to caring for our Members. Our emphasis is on encouraging proactive health care and offering programs and services that can make a difference in our Members, your patients’, quality of life.

We believe in providing our Members exceptional benefits and an abundance of attention. And, we believe Simpra Advantage providers deserve the same.

Simpra Advantage (PPO SNP) firmly believes that our success as a health plan hinges on our participating providers. And we are committed to simplifying the administration of health insurance so our providers can devote their attention to providing high-quality health care.

We are always available if questions arise, and we collaborate with our providers to help ensure the efficient delivery of superior care to our members.

EZ-NET Provider Portal Access

If you are a current Simpra Advantage provider, log-in to use the EZ-NET Provider Portal. Or, click here to submit a batch of claims.

The Simpra Advantage EZ NET Provider Portal offers Providers secure, web-based access to healthcare information, including claims, eligibility, benefits, and authorizations. And, its secure method protects the HIPAA privacy of our Members.

The EZ-NET Provider Portal allows Providers access to:

  • Submit authorizations requests and claims into the EZ CAP system
  • Inquire on authorization status
  • Verify Member eligibility
  • View Member authorization history
  • Check the status of claims/encounter information
  • Look up procedure codes, diagnosis codes, and other general reference information

New User Registration

Providers can register a new user through the New User Registration link on the EZ-NET Provider Portal.

An example of the pre-login page is shown below.

After registering as a New User, you will receive a confirmation email message asking you to verify your account. The email will be sent to the email address you provided. To confirm your account, click on the confirmation link provided in the email.

Once the EZ-CAP Administrator verifies your account in EZ-CAP, you will be notified that your EZ-NET login is fully activated; and you will receive directions on how to access the EZ-NET Provider Portal.

Retrieve Password / Reset Password / Retrieve Username

For a forgotten username or password, Providers should click on “Forgot Username/Password” on the EZ-NET Provider Portal. An example of the pre-login page is shown below.

You will be taken to a new screen where you will enter your User Name and Email Address to Retrieve Your Password.

Click “Clear” to clear all entries or click “Next” to submit request to Reset Your Password.

Click on the hyperlink “Forgot your Username” to retrieve your username. (Note – this will only work if the Password Recovery Question and Answer Setup has been created.)

Electronic Claims Submission (Exchange EDI)

Providers can submit claims directly through our clearinghouse or through your current system and receive your payments electronically, but you need to sign up!

Here is the information on how to contact us in order to sign up:

Customer Support Telephone Number: 1-888-635-0009, Choose Option 2
Website address: http://exchangeedi.com/quick-links

From the site, providers can obtain the companion guide, the enrollment form, and information on how to enroll.

For ease of processing payment, electronic claims are preferred; however, if you are unable to send us a claim electronically, please mail it to:

Simpra Advantage
PO Box 908
Addison, TX 75001-0908

For Prescribers & Pharmacies

Simpra Advantage provides Medicare Part D prescription drug coverage through our partner Navitus Health Solutions.

Navitus Health Solutions is a full-service pharmacy benefit management company committed to lowering drug costs, improving health, and providing superior customer service in a manner that instills trust and confidence.

For Prescribers:

  • Access Formulary and Prior Authorization Forms at www.navitus.com
  • Select “Prescribers” and click on “Prior Authorization”
  • Enter your NPI number and State to access the prescriber portal
  • Navitus Health Solutions Pharmacy Helpdesk
    • Phone number: 1-866-270-3877
    • TTY phone number: 711

Refer to the Prescription Drug Benefit page for formulary, prior authorization criteria, and step therapy criteria

For Pharmacies:

  • Access payer sheets and other information at www.navitus.com
  • Select “Pharmacies” and click “Pharmacies Login”
  • Enter your NPI number and NCPDP number to access the pharmacy portal
  • Navitus Health Solutions Pharmacy Helpdesk .
    • Phone number: 1-866-270-3877
    • TTY phone number: 711

Refer to the Prescription Drug Benefit page for formulary, prior authorization criteria, and step therapy criteria

Institutional Special Needs Plan Model of Care & Training

At Simpra Advantage, we specialize in improving health care and advancing a truly unique philosophy of care to meet the complex needs of the institutional Medicare beneficiary population, while simultaneously streamlining administrative functions for our Providers.

The Simpra Advantage Model of Care focuses on providing a unique level of customized clinical care and services for residents in nursing facilities. As we help extend your care, our care model concentrates on addressing each Member’s full range of medical, functional, and behavioral health care needs in a coordinated and Member-centric manner. This means putting the Member’s preferences at the center of the care planning process and leveraging Provider resources to ensure every Member receives the services necessary to achieve their short- and long-term care goals.

Our model organizes best practices and industry innovations including:

  • The Advanced Nurse Practitioner (ANP) and primary care physician (PCP)/NFist (a PCP specializing in the care of nursing home patients) care team providing onsite, facility-based PCP support;
  • A risk-assessment tool designed for a senior, nursing facility patient population;
  • A comprehensive history and physical assessment that generates an Individualized Care Plan (ICP);
  • A care management platform that helps identify needed preventive health/HEDIS services, ensures the use of evidence-based clinical guidelines, and facilitates care team communications for care coordination; and
  • Frequent face-to-face Member and caregiver/family member interactions that identify Member care preferences and allow time for important care decision discussions and counseling.

It is important that all of our Providers are properly trained and informed about the Simpra Advantage Model of Care. Our top priority is making sure all of the providers in the Simpra Advantage network meet the training and education needs of our institutional Medicare beneficiary population. The purpose of the Model of Care Training is to comply with the statutory requirement of the Centers for Medicare and Medicaid Services (CMS), that all Special Needs Plans provide a general understanding of the requirements of the Model of Care. In addition, this will also help you to seamlessly serve Simpra Advantage Members, your patients.

Become a Simpra Advantage Network Provider

Simpra Advantage contracts with physicians, facilities and other allied providers to ensure we have an adequate provider network which is essential for the delivery of health care services to our members. All providers must be credentialed before they can be added to our network as a participating provider.

Why Partner with Simpra Advantage:

  • From the beginning, physicians discover that Simpra Advantage isn’t just another Medicare Advantage health plan.
  • We have a different philosophy, attitude and approach to caring for our Members.
  • Our emphasis is on encouraging proactive health care and offering programs and services that can make a difference in our Members/your patients’ quality of life.
  • We believe in providing our Members exceptional benefits and an abundance of attention.
  • And we believe Simpra Advantage (PPO SNP) providers deserve the same.

For more information on becoming a Simpra Advantage contracted provider, please contact Network Operations at 1-844-637-4770 (TTY: 711) or via email at networksupport@simpra.com.

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