Security Health Plan distributes
Provider News
digitally. Information in this newsletter is important for care providers, clinic managers, patient assistance, coding and other clinic staff. Please share with your colleagues.
If you wish to receive this monthly newsletter, please create a Provider Portal account by contacting your practice's organization administrator. If you don't have an organization administrator,
click here
to set one up.
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In response to the novel coronavirus (COVID-19) outbreak, Security Health Plan has developed processes for providers and a webpage to help answer questions about testing and treatment. Access our
COVID-19 web page
for timely updates.
Click here
to go directly to our most recent COVID-19 Provider FAQ.
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Security Health Plan adopts permanent policy for telehealth services
Effective Aug. 1, 2020, Security Health Plan covers telehealth services as outlined in its now permanent Telehealth Medical Policy. View
Telehealth Medical Policy
.
The coverage outlined in the Telehealth Medical Policy covers providers who are credentialed and affiliated with Security Health Plan. Telehealth visits will be reimbursed according to the provider’s current Security Health Plan contracted rate. The member’s plan cost sharing will apply.
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Security Health Plan flyer promotes wearing of masks
Security Health Plan has developed this "Wear a mask - slow the spread" educational poster to explain how wearing of masks can protect those around you from being exposed to COVID-19. Providers are welcome to print and share this poster with their patients.
Click here to view and save the poster.
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Use Provider Portal to verify claims information
Claim status, eligibility, benefits and prior authorization requirements can be verified on the Security Health Plan Provider Portal.
Click here
for information on Provider Portal access and other ways to get the information you need by email, phone and fax.
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Hierarchical condition categories (HCC) coding and vascular disease - Medicare Advantage patients
By BRENDA ANDERSON, Revenue Management Educator
More than 500 diagnosis codes are associated with HCC 106, 107 and 108 in the vascular disease category of the CMS Medicare Advantage risk adjustment payment model. This category is consistently near the top of the list with the most prevalent coding gaps.
Read more
for details on frequently missed diagnoses and ways your documentation and coding can significantly impact revenue received to provide care.
HCC coding for reactive airway disease and asthma - Federally Facilitated Exchange (FFE) patients
By BRENDA ANDERSON, Revenue Management Educator
Security Health Plan is concerned about provider understanding of diagnosis coding related to asthma and reactive airway disease.
Read more
to assure complete and accurate coding of your FFE patients' diagnoses.
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Security Health Plan policy review - July 2020
By KAREN BORGEMOEN, Nurse Navigator / Medical Policy Nurse
Security Health Plan reviews medical policies on a monthly basis. Medical policies are found in the provider section of the Plan's public website.
Read more
for policy reviews and changes effective July 1, 2020.
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Provider expertise requested for medical policies and criteria
As Security Health Plan reviews and develops clinical criteria on Medical and Interpretation Policies, we ask providers with particular professional knowledge or clinical expertise on certain subjects for their input and opinions.
To receive payment, providers must meet all policy criteria outlined for the specific service provided.
Please review the current month’s medical policy updates and/or changes at
www.securityhealth.org/medicalpolicies.
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Security Health Plan updates
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eviCore updates program/guidelines for chest imaging
By THERESA STERNIK, Health Services Clinical Manager
eviCore has announced several updates to its program/guidelines for chest imaging related to COVID-19. The updates will be effective Oct. 1, 2020, and will be posted to the Radiation Oncology Solution on eviCore.com.
Read more for a list of the updates.
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Unclassified medical benefit drug form updated on Security's website
Several medications have been removed from the Security Health Plan form used for prior authorization of unclassified medical benefit drugs. Removed drugs include Gamifant (emapalumab), Libtayo (cemiplimab-rwlc), Lumoxiti (moxetumomab pasudotox-tdfk) and Takhzyro (lanadelumab-flyo).
Click here
to view the updated prior authorization form.
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Wisconsin DHS gives Medicaid patients the right to file
appeals, grievances
By LINDSEY TAUSCHEK, Provider Network Data Integrity Analyst
Wisconsin Department of Health Services (DHS) allows Medicaid members the right to file an appeal for services provided by their BadgerCare Plus HMO. DHS also allows Medicaid members the right to file a grievance for all non-benefit related concerns. Security Health Plan provides its affiliated Security Health Plan BadgerCare providers with the information detailing the grievance and appeals requirements.
Read more
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Important online information is a click away
For a list of information available at your fingertips in the provider manual,
click here.
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Security Health Plan partners with LexisNexis Risk Solutions and AMA Business Solutions to verify provider information
By DAVID NYMAN, Director, Payor Strategy and Network Contracting
As you know, it is vital that your patients have access to accurate, up-to-date information about their providers in the Security Health Plan Provider Directory. Security Health Plan is required to attest to the accuracy of its provider network information to various state and federal entities. Additionally, CMS requires that providers review and update their information quarterly or whenever there is a significant change. To help you meet this requirement, Security Health Plan has engaged with the search firm LexisNexis Risk Solutions and the American Medical Association’s AMA Business Solutions.
Read more
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Prior authorization updates
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October 2020 updates to medication prior authorizations and post service claim edits
By AMANDA SIEGLER,
Clinical Pharmacy Specialist
Security Health Plan requires prior authorization (PA) and post service claim edits (PSCE) on medications in order to ensure coverage and payment for those services. A number of requirements have been added for 2020 as we work to make sure all care, services and treatments are medically necessary.
Read more
for PA and PSCE updates effective Oct. 1, 2020.
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Security removes certain skin-related prior authorization requirements for Medicare Advantage members
As of July 1, 2020, Security Health Plan has removed the prior authorization requirement for Medicare Advantage plans ONLY from the Skin Substitutes, Chemical Peels, Dermabrasion, and other Skin Procedures medical policy. Security Health Plan is following Medicare guidelines for the coverage of services. All other plans (commercial, BadgerCare, Family Health Center and Security Administrative Services) still require prior authorization.
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Help patients find you
- Has your practice moved?
- Have you changed the name or ownership of your practice?
- Do all of your providers accept new patients?
- Is anyone seeing patients in a new or different location?
- Has anyone left your practice or been replaced in the last year?
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Help patients find you by keeping information about your practice current with Security Health Plan.
Security Health Plan’s online provider directory is the primary provider search tool we offer our members. Members use the “Find a Doctor” directory to search for providers who can fill their specific care needs, whether they’re looking for a primary care provider who sees children, a specialist with privileges at a specific hospital, or an affiliated nursing home near their aging parents.
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To help patients find you, visit
www.securityhealth.org/directory
. Whether you’re a provider, a practice or a facility, please review the directory information for accuracy.
Be sure to contact us right away with any needed updates: You can report a change to Provider Relations staff. Call us at
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