Security Health Plan now 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 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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Customer Service team earns service excellence awards
The world class customer service team at Security Health Plan has earned three more service quality awards from Service Quality Measurement (SQM) for 2018.
Read more
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HCC coding impacts risk scores and revenue
By BRENDA ANDERSON, Revenue Management Educator
The Hierarchical Condition Category (HCC) risk adjustment payment model is used by the Centers for Medicare and Medicaid Services (CMS) to predict the cost of care for Medicare Advantage beneficiaries. CMS requires that “risk adjusted” conditions or those associated with a HCC be documented and coded at least once each calendar year. Complete and accurate documentation and coding are required to assure correct reimbursement for present and future care of patients.
Read more
about HCC coding. Also see the CON14 RADV audit story below.
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Security Health Plan selected for CON14 RADV audit
By HELEN BROWN, Risk Adjustment Revenue Manager
Security Health Plan has been selected for a Medicare Part C Contract-Level Risk Adjustment Data Validation (CON14 RADV) audit. This audit is a CMS requirement due to Security Health Plan’s participation in the risk adjustment process for our Medicare Advantage contracts.
Providers play a significant role in the risk adjustment program. Complete and accurate documentation of diagnoses by providers is key to the success of risk adjustment.
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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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Provider should verify Part B drug benefits for Medicare Advantage members
Step therapy initiated for Part B macular degeneration and
anemia injections
By ASHLEY GURALSKI, Assistant Manager, Government Claims
Security Health Plan's Medicare Advantage plans, including eight HMO-POS plans and Ally Rx D-SNP, provide coverage for Part B drugs administered in an office or outpatient setting. Because benefits may differ based on the member’s eligibility, please verify member-specific eligibility and benefits by logging into our online Provider Portal.
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“FY” payment reduction modifier for X-rays using cassettes to be implemented with additional plans
By KATE SCHMUTZER, Provider Contracting Manager
Security Health Plan had previously implemented a new Medicare payment reduction modifier to our Medicare Advantage plans. On July 1, 2019, Security Health Plan will implement the new modifier for our Commercial and Security Administrative Services products.
The FY modifier indicates that the X-ray was taken using a cassette. A payment reduction of 7 percent will apply to the technical component (and the technical component of the global fee) when using X-ray equipment that requires the use of a cassette to take an X-ray. The FY modifier is billed in conjunction with the TC modifier.
Note that the beneficiary is NOT liable for the FY modifier payment reduction. For more information please contact your Provider Relations contract manager at
715-221-9640.
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Member compliance required for continued authorization of positive airway pressure treatment
By THERESA STERNIK, Health Services Nurse Manager
To receive the maximum benefit from positive airway pressure (PAP) treatment, the Security Health Plan member must be compliant with therapy. This requires using the PAP device for at least 4 hours each night for at least 21 nights during a 30 day period, or as prescribed by the treating physician.
Read more
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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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Security Health Plan to implement CMS multiple procedure payment reductions (MPPR) for diagnostic imaging
By JENNIFER DENNEE, Government Policy and Reimbursement Specialist
Effective July 1, 2019, Security Health Plan will implement guidelines from the Centers for Medicare and Medicaid Services (CMS) when multiple diagnostic imaging procedures are performed in a single session on the same patient by the same group physician and/or other health care professionals.
Read more
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Process explained for submitting corrected claims or adjustment request forms
By ROBYN SCHINDLER, Provider Relations Account Manager
Corrected claims are required when facilities have found a charge or charges that need to be added or corrected. Adjustment request forms are required when facilities need to delete, report duplicate payment, or provide a refund.
Read more
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Security Health Plan policy review - March and April 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
March and April 2019 policy reviews and changes.
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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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July 2019 updates to prior authorization and post service
claim edits
By AMANDA SIEGLER, Clinical Pharmacy Specialist
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.
Read more
for PAs and PSCEs effective
July 1, 2019
.
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Security Health Plan partners with eviCore healthcare for musculoskeletal and therapy prior authorizations effective May 1, 2019
By THERESA STERNIK, Health Services Nurse Manager
Security Health Plan and eviCore healthcare are pleased to announce their partnership to provide authorization services for patients enrolled in Security Health Plan’s Commercial, BadgerCare Plus, Medicare Advantage and Security Administrative Services plans.
eviCore will facilitate prior authorization for certain musculoskeletal and therapy services for dates of service beginning
May 1, 2019.
Read more
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Prior authorization requirement through eviCore effective July 1, 2019, for cardiac imaging and sleep management services
Security Health Plan and eviCore healthcare are pleased to announce their partnership to provide authorization services for patients enrolled in Security Health Plan’s Commercial, BadgerCare Plus, Medicare Advantage and Security Administrative Services plans.
eviCore will facilitate prior authorization for cardiac imaging and sleep management services for dates of service beginning
July 1, 2019.
Read more
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Security Health Plan now handles prior authorization for acute rehabilitation and long term acute care admissions
Effective
March 1, 2019,
responsibility for
prior authorizations (PA) for acute rehabilitation and long term acute care inpatient admissions has transitioned from naviHealth to Security Health Plan. All new inpatient admissions will require PA with Security Health Plan.
Read more
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Prior authorizations for secondary insurance coverage, worker’s compensation/liability and radiation therapy
Click here to review prior authorization requirements regarding secondary insurance coverage, worker's compensation/liability and radiation therapy treatments.
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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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