Provider
News
January 2019
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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.
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B
enefit specialist fights to save member more than $7,000
One Security Health Plan member saves over $7,000 after a phone call with a Security Health Plan customer service representative takes a turn for the best.
Read more
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Medicare Advantage Open Enrollment Period returns
The Medicare Advantage Open Enrollment Period (OEP) returns for 2019. Between Jan. 1 and March 31, individuals enrolled in a Medicare Advantage (MA) plan are allowed to make a one-time election to go to another MA plan or Original Medicare.
Additionally, beneficiaries who enroll in an MA plan during their Initial Coverage Election Period throughout the year have a similar opportunity to make one plan change. Their OEP begins on their month of entitlement to Part A and Part B and ends on the last day of their 3
rd
month of entitlement.
The member needs to be enrolled in an MA plan to have this election. This is not an opportunity for those on Original Medicare to pick up an MA plan. Individuals can add or drop Part D as part of the switch. The effective date for the new plan will be the first of the month following receipt of the request.
Please note that members of Medicare Medical Savings Account, Cost and Pace plans are excluded.
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Documenting and Coding Updates for BMI, Overweight, Obesity and Morbid Obesity
By BRENDA ANDERSON, Revenue Management Educator
The
Fourth Quarter AHA Coding Clinic for ICD-10-CM and ICD-10-PCS
, the official resource for diagnostic coding, recently provided updates on documentation and coding of BMI, overweight, obesity and morbid obesity.
Read more
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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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Security Health Plan to implement new opioid pharmacy point-of-sale claim edits for 2019
By MARC MEVERDEN, Clinical Pharmacy Services Manager
As recommended by the Center for Medicare and Medicaid Services (CMS), Security Health Plan and other sponsors will be implementing pharmacy point‐of‐sale safety edits as a proactive step to improve the safety and effectiveness of pain treatment and reduce the risks of long-term opioid therapy.
Some of these programs will require provider intervention.
Read more
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Drug management program limits access to opioids and benzodiazepines
By MARC MEVERDEN, Clinical Pharmacy Services Manager
In addition to the pharmacy point-of-sale claim edits, Security Health Plan (SHP) has a drug management program (DMP) that limits access to opioids and benzodiazepines for patients who are considered to be at-risk for prescription drug abuse.
Read more
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Routine vision coverage removed for 2019
from individual and family plans
Beginning in the 2019 plan year, Security Health Plan will
not
cover preventive and routine adult vision exams for its commercial individual and family plan members. Security Health Plan
will
cover adult vision exams directly related to the management of a condition, including but not limited to diabetes, glaucoma and retinal detachment.
Please note, if a health care provider bills the adult vision service as preventive, it will not be covered.
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Security Health Plan initiates home infusion site of service program
By AMANDA SIEGLER, Clinical Pharmacy Specialist
Effective for dates of service on or after Jan. 1, 2019, Security Health Plan has expanded access to home infusion medications.
Check our website
for a list of medications that are eligible for home infusion.
Read more
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Medical policies moved to Security Health Plan public website
Security Health Plan's medical policies have been moved to 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. See the
policies web page
for more information.
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Prior authorization updates
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Prior authorization and post service claim edits updates for 2019
By THERESA STERNIK, Health Services Nurse Manager
Security Health Plan requires prior authorization (PA) or post service claim edits (PSCE) for certain medical services and prescription 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.
Read more
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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
715-221-9640
(TTY: 711), fax changes to us at
715-221-9699
or email us at
[email protected]
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