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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We take care of our communities
As a nonprofit organization, Security Health Plan is focused on helping people and communities achieve their best health.
Read more
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Security Health Plan joins measles vaccine effort
Security Health Plan is committed to helping government agencies, health care providers and community agencies in the effort to prevent the spread of measles as it is at a 25 year high in the United States. It is vitally important that all providers’ offices continue to emphasize the importance of MMR vaccination to their patients at appointments.
Read more
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Workshop aims to help people quit nicotine use
Security Health Plan and the Marshfield Clinic Health System are hosting
Nicotine-Free workshops
in Marshfield in July.
The workshops are limited to 12 persons, but all of your patients who are Security Health Plan members can take advantage of free telephonic health coaching at any time.
Read more
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Bridging language differences between clinical standards and coding guidelines is key for accuracy
By BRENDA ANDERSON, Revenue Management Educator
Providers and coders rely on each other to perform their jobs efficiently and accurately; however, the two do not always speak the same language. This is partially due to the differences between clinical training and standards, and the ICD 10 coding guidelines that a coder must follow. This can lead to frustration and additional work for both parties.
Read more
about some specific areas where differences exist and where efficiencies and accuracy can be gained.
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HHS risk adjustment audit coming soon
By BETH KRULL, Program Specialist - Government Products
Every year the Department of Health & Human Services (HHS) and Centers Medicare and Medicaid Services (CMS) require Security Health Plan to participate in a risk adjustment data validation (RADV) audit. We may contact you to request medical records for Security Health Plan members enrolled in an Affordable Care Act plan.
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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Electronic payments available for providers enrolled with Zelis Payments
By STEPHANIE BAUER, Assistant Director of Claims and Business Configuration
Effective July 8, 2019, Security Health Plan will begin paying providers electronically who are enrolled with Zelis Payments but today receive paper checks from Security Health Plan. Payments will be made utilizing your current Zelis payment method selection of either Direct Deposit or Virtual Payment Card.
Read more
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CMS designates Livanta BFCC-QIO as Quality Improvement Organization for Wisconsin
By SHELLEY KRESS, Provider Contracting Manager
The Centers for Medicare and Medicaid Services has notified Security Health Plan that they have updated the regional quality improvement organization (QIO) contractors who do case review work for beneficiary appeals and quality-of-care reviews.
Effective June 8, 2019,
Livanta BFCC-QIO Program replaced KEPRO as the QIO for Region 5 including Wisconsin.
Read more
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Security Administrative Services claims move to Security Health Plan processing platform
By ROBYN SCHINDLER, Provider Relations Account Manager
Effective June 1, 2019, Security Administrative Services (SAS) moved all claims to the Security Health Plan claims processing platform. Also effective June 1, 2019, provider access to the old SAS portal is being terminated. Providers should begin accessing all SAS information from the Security Health Plan Provider Portal
.
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Security Health Plan announces new names for its large employer networks
Effective July 1, 2019, Security Health Plan's large employer networks will be renamed to better capture the Plan's brand identity and alleviate potential confusion over eligibility based on geographical location.
Read more
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Network name changes impact 270/271 information exchange
As a result of these network name changes, there will be some updates to the 270/271 information exchange. In addition, Security Health Plan recently received CAQH certification and will convert to a CAQH certified connection for 270/271.
Read more
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Security Administrative Services will become employer product of Security Health Plan in 2020
Security Administrative Services (SAS) will become a product of Security Health Plan, effective January 1, 2020. SAS will transition from having its own branding to be branded as a Security Health Plan employer product. There will be no change to SAS services, just a change in how SAS is presented as part of the Security Health Plan family of products.
Security Administrative Services, a wholly owned subsidiary of Security Health Plan, provides full service third party administration for self-funded employers in Wisconsin, Indiana, and Michigan.
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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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Portal access should be shared only within practice
Security Health Plan providers are reminded that when requesting access to Security Health Plan’s Provider Portal, they agree to grant access only to users within the same practice. Providers are not allowed to share usernames and passwords with third parties, nor are they to set up access to anyone outside their organization. Any such activity could warrant Security Health Plan terminating their portal access.
Use the Provider Access Request
linked here
and found on the Provider Portal to request access for users in your practice.
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Security Health Plan policy review - May and June 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
May and June 2019 policy reviews and changes.
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Required action:
Check databases for excluded employees, vendors
By ALLIE WEIN, Privacy Specialist
Security Health Plan’s contracted providers are required to check the Office of the Inspector General (OIG) List of Excluded Individuals and Entities (LEIE) and System for Award Management (SAM) Excluded Parties List System (EPLS) websites to verify that your employees and any other downstream vendors you use that may receive Medicare and Medicaid dollars do not appear on these lists.
Read more
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Prior authorization updates
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Prior authorization requirement effective July 1 for cardiac imaging and sleep management services
By KAREN BORGEMOEN, Nurse Navigator / Medical Policy Nurse
Security Health Plan and eviCore healthcare are pleased to announce their partnership to provide authorization services. 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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Who is eviCore healthcare? Questions and answers
By DAVID NYMAN,
Director, Payor Strategy and Network Contracting
eviCore healthcare is an independent specialty medical benefits management company that provides targeted utilization management services for Security Health Plan.
Read more
for a discussion of common provider questions and answers.
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Prior authorization removed for certain specialty consults for State of Wisconsin/ETF members
By KAREN BORGEMOEN, Nurse Navigator / Medical Policy Nurse
Effective July 1, 2019, prior authorization will no longer be required for State of Wisconsin/Employee Trust Fund (ETF) members to receive a specialty consult for the following conditions:
- carpal tunnel - median neuropathy
- chronic hip pain - osteoarthritis
- chronic knee pain – osteoarthritis or meniscal degeneration
- hysterectomies for diagnosis of fibroids
ETF members also will not be required to do shared decision making for
carpal tunnel diagnosis, chronic hip/knee pain and hysterectomies
. Prior authorization and shared decision making will continue to be required for ETF members to receive an orthopedic or neurosurgery specialty consult for
low back pain
.
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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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