Provider News
September 2020
|
|
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.
|
|
Check back often to see how Security Health Plan processes help minimize COVID-19 impact on providers
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.
|
|
October is Breast Cancer Awareness Month
Providers are welcome to save and use our "Think Pink in October" Breast Cancer Awareness Month poster. Click here to view and save the poster.
Protect yourself. Protect others. Get a flu shot.
The single best way for your patients to prevent the flu is the flu vaccine. The Centers for Disease Control and Prevention recommends everyone age six months and older be vaccinated. It’s more important than ever to get the flu shot early this year during the coronavirus pandemic to protect at-risk populations and reduce the burden on the health care system.
|
|
|
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.
|
|
Hierarchical condition categories (HCC) coding -
Alzheimer's disease and dementia
By BRENDA ANDERSON, Revenue Management Educator
The Centers for Disease Control predicts the number of individuals with Alzheimer’s disease and related dementia will grow significantly in the aging population of the United States. Making the diagnosis early and providing care for your patient, as well as support to their family, is important to your patient’s health and quality of life. Specificity in documentation and coding is essential to assigning an accurate diagnosis code and associated risk factor coefficient to patients with the condition. Read more
|
|
Security Health Plan policy review - effective September 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 Sept. 1, 2020.
|
|
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.
|
|
Security Health Plan updates |
|
Electronic visit verification to be required for all personal care services
By JEFF KEAN, Implementation Manager
Security Health Plan requires prior authorization for all personal care services. Please see the “Home Care Coverage Criteria” medical policy on the Security Health Plan Medical Policy page for information on prior authorization criteria. In alignment with Fee for Service Medicaid, Security Health Plan will require electronic visit verification (EVV) for all claims for personal care worker services with a “soft launch” effective date of Nov. 2, 2020. Read more
|
|
Medicare Part B step therapy program adds drug
By KURT WITTIG, Clinical Pharmacy Specialist
In line with CMS guidance to apply step therapy for physician-administered Part B drugs in a way that lowers costs and improves the quality of care for Medicare beneficiaries, Security Health Plan is adding Nyvepria(R) (pegfilgrastim-apgf) to the program for dates of service on or after Dec. 1, 2020. Read more
|
|
Security Health Plan introduces level-funded plan for 2021
Security Health Plan will be offering employers a new level-funded effective Jan. 1, 2021. Level-funded plans offer employers a plan where they contribute a set dollar amount monthly to cover claims similar to a fully-insured premium. This works well for small employers with 10-100 employees who are generally healthy individuals by blending the economic advantages of self-funding with the financial predictability of fully funded plans. Read more
|
|
Online manuals make it easy to work with Security Health Plan
By KATE SCHMUTZER, Provider Network Contracting Manager
The Provider and Member tabs on our website at www.securityhealth.org make it easy for you to find important information on our services, standards and processes. Read more for information on our Provider Manual, Credentialing Program Manual and helpful member documents.
|
|
Provider access standards assure timely access to health care services
By RHONDA LOKKEN, Provider Relations Account Manager
All Security Health Plan members have the right to receive timely access to medically necessary health care services. Security annually evaluates its affiliated providers’ compliance with these standards. Read more
|
|
After-hour coverage requirements for Security Health Plan network providers
By RHONDA LOKKEN, Provider Relations Account Manager
Primary care providers and behavioral health providers must have a system in place for ensuring accessibility after hours for their patients, and for informing their patients about how to access after-hour care.
- After-hour patient telephone calls should be returned within 1 hour from the time call was placed by the patient.
- All providers will be required to provide patients with an emergency telephone number including a description of 24-hour/day access to health care for use after regular office hours.
- Physicians who accept “on-call” responsibility for network primary care providers and specialty care physicians are subject to the same standards for access and availability.
|
|
Prior authorization updates |
|
Prior authorization requirement removed for autism service
By THERESA STERNIK, Health Services Clinical Manager
Effective Jan. 1, 2021, Security Health Plan will no longer have the requirement for prior authorization for autism non-intensive services. This will be effective for dates of service after Jan. 1, 2021. The change will impact the products that have an autism benefit: Badgercare, Commercial and Security Administrative Services. Read more
Security Health Plan, eviCore streamline prior authorization process
Security Health Plan is working with eviCore healthcare to streamline the prior authorization process using the new eviCore intelliPath technology with natural language processing and artificial intelligence. As this technology is implemented in the next several months, you may notice:
- More approvals will occur immediately for Radiology and Cardiology only;
- Less time will be spent answering clinical questionnaires;
- The office will spend less time in eviCore portals or on the phone with eviCore to submit authorizations; and
- eviCore will need to request additional information less often.
|
|
January 2021 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 2021 as we work to make sure all care, services and treatments are medically necessary. Read more for PA and PSCE updates effective Jan. 1, 2021.
|
|
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].
|
|
|
|
|
|
|
