Provider News February 2019

Security Health Plan now distributes Provider News digitally. Don't forget to share with your colleagues. If you wish to receive this bi-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.

Proud of it

Security Health Plan's health coaching offers a different approach to success Security Health Plan health coaching is different. The health coaches at Security Health Plan use a different way to help members be successful in areas like losing weight, quitting tobacco and managing stress. The story of Kris Nilsson (seated), shown here with health coach Anna Stichert, is a great example of how health coaching is changing lives for Security Health Plan members. Read more

News from our partners

Medicare initiates list of precluded providers By KATE SCHMUTZER, Provider Contracting Manager Starting January 1, 2019, the Centers for Medicare and Medicaid Services (CMS) started issuing a list of providers and prescribers who are precluded from receiving payment for Medicare Advantage items and services or Part D drugs furnished or prescribed to Medicare beneficiaries. CMS will make the preclusion list available to Part D sponsors and Medicare Advantage plans, starting January 1, 2019, and effective April 1, 2019.  Read more

Coding corner

Cardiomyopathy HCC coding requires specificity By ANN MEVERDEN, Revenue Management Educator Cardiomyopathy is an HCC diagnosis that is frequently miscoded due to a lack of specificity. Most types of cardiomyopathy are associated with an HCC in the CMS Medicare Advantage payment model, but ischemic cardiomyopathy is NOT. Therefore, when known, it is very important to document and code the specific type of cardiomyopathy (ischemic cardiomyopathy vs. dilated cardiomyopathy) you are addressing.  Read more

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. Requests from providers must be documented on the Provider Input Form . Please download the form from www.securityhealth.org/medicalpolicies. Then, email the completed form to [email protected]. We appreciate your input. 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.

Security Health Plan updates

Security Health Plan is applying MIPS to Medicare Advantage claim payments effective Jan. 1, 2019 By APRIL BORES, Manager, Government Claims In alignment with guidance from the Centers for Medicare and Medicaid Services (CMS), Security Health Plan is now applying the Merit-based Incentive Payment System (MIPS), effective for Medicare Advantage claims with date of service Jan. 1, 2019, and forward.  Read more

Policy changes could improve provider payments for denied worker's compensation claims By KATE SCHMUTZER, Provider Contracting Manager and SARA SKRZECZKOSKI, Subrogation Manager Effective March 15, 2019, Security Health Plan will update an existing policy regarding Worker’s Compensation (WC) claim payments that is expected to also benefit healthcare providers.  Read more

Security Health Plan to initiate step therapy with new starts for certain Part B drugs  By KURT WITTIG, Clinical Pharmacy Specialist The Centers for Medicare and Medicaid Services (CMS) recently issued guidance that provides Medicare Advantage plans the option of applying step therapy for physician-administered Part B drugs in a way that lowers costs and improves the quality of care for Medicare beneficiaries. Effective May 1, 2019, Security Health Plan will implement step therapy requirements for new starts of certain Part B drugs.   Read more

Provider statements corrected  By STEPHANIE BAUER, Assistant Director, Claims and Business Configuration In May 2018 we made changes to the Security Health Plan provider statements. Recently we identified these changes may have impacted the accuracy of the printed dates of service and claim subtotal lines on the statements. However, the changes did not affect provider payments and all dollar amounts on the statements are accurate.  Read more

Use Provider Portal to verify claims information By SOMMER WEILAND, Assistant Manager, Commercial Claims Claim status, eligibility, benefits and prior authorization requirements can be verified on the Security Health Plan Provider Portal. Check the full story for information on Provider Portal access and other ways to get the information you need by email, phone and fax.  Read more

Workshop to help people kick the nicotine habit  Do you have patients who smoke, chew or vape and want to quit? Security Health Plan and Marshfield Clinic have teamed up to offer Nicotine Free, an interactive workshop focusing on tobacco and nicotine cessation. Security Health Plan members unable to attend the workshop can take advantage of free health coaching by telephone at any time.   Read more

Security Health Plan policy review - January 2019  Security Health Plan reviews medical policies on a monthly basis. Medical policies are found in the provider section of the Plan's public website. As we review and develop clinical criteria for our policies, providers with particular professional knowledge or clinical expertise on certain subjects are invited to provide input and opinions. Read more for January 2019 policy reviews and changes.

Prior authorization updates

2019 updates to prior authorization and post service claim edits By THERESA STERNIK, Health Services Nurse Manager Security Health Plan requires prior authorization or post service claim edits (PSCE) for certain medical services, care, equipment and medications in order to ensure coverage and payment for those services. A number of requirements have been added for 2019 as we work to make sure all care, services and treatments are medically necessary. Several PSCEs begin July 1, 2019.  Read more

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?

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.

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 715-221-9640 (TTY: 711), fax changes to us at 715-221-9699 or email us at [email protected] .

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