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  • Simply Healthcare Medication Prior Authorization Form 2012

Get Simply Healthcare Medication Prior Authorization Form 2012-2025

â–¡ Expedited* By checking this box I certify that applying the standard 72-hour review time frame may seriously jeopardize the life or health of the patient or the patient's ability to regain maximum function. Prescriber Information Name: NPI: Phone Number: Specialty: Fax number: Medication Requested: (Please include name, strength, quantity and directions): Estimated duration of therapy: Diagnosis and pertinent clinical information: Previous medications tried for this diagnosis and when.

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Our Medicaid and Florida Healthy Kids plans Simply serves members in Florida's Statewide Medicaid Managed Care Managed Medical Assistance (MMA) and Long-Term Care (LTC) programs, as well as members enrolled in Florida Healthy Kids.

Simply Healthcare Holdings was acquired by Elevance Health on Dec 22, 2014 .

Simply is a managed care organization serving Statewide Medicaid Managed Care Managed Medical Assistance (SMMC MMA), Florida Healthy Kids and Statewide Medicaid Managed Care Long-Term Care (SMMC LTC) members in Florida.

We will cover your use of a medicine from the Preferred Drug List as long as there is a medical need for you to be on it. You also need to fill your prescription at a Humana network pharmacy and follow other plan rules. The Agency for Health Care Administration (AHCA) also makes this information available.

Florida KidCare is the umbrella brand for the four government-sponsored health insurance programs – Medicaid, MediKids, Florida Healthy Kids and the Children's Medical Services (CMS) Health Plan – that together provide a seamless continuum of coverage for Florida children from birth through the end of age 18.

Prior approval is required for all services by a provider who is not in the Sunshine Health network. The only exception is for emergency care. Emergency room or urgent care visits do not require prior authorization.

Statewide Medicaid Managed Care (SMMC) is the program where most Medicaid recipients receive their Medicaid services.

In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program. The program has three parts: Managed Medical Assistance, Long-Term Care, and Dental.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232