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.
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Living Well: learning to manage chronic health conditions
Security Health Plan and Aging and Disability Resource Centers team up to offer workshops throughout Wisconsin for people dealing with chronic medical conditions. Learn how the workshop put a central Wisconsin couple on the path to better health.
Read more
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Security Health Plan among leaders in national ratings
NCQA 4.5 and 4.0 ratings among the best in Wisconsin
For the 14th consecutive year, Security Health Plan of Wisconsin, Inc., is among the nation's highest-rated health insurance plans by the National Committee for Quality Assurance (NCQA) for its Medicare, Medicaid and Commercial plans.
In the 2018-19 NCQA Health Insurance Plan Ratings released in September, Security Health Plan's Medicare plans were rated 4.5 out of 5, while its Commercial plans and Medicaid (BadgerCare Plus) plans each received a 4.0 out of 5 rating.
Read more
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Julie Brussow, CEO
Security Health Plan
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CMS recognizes Medicare Advantage plan quality with 4.5 star rating
Security Health Plan of Wisconsin, Inc., has again been recognized among the nation’s leading health plans by the Centers for Medicare and Medicaid Services for 2019.
Security Health Plan remains among the highest-rated Wisconsin plans with an overall rating of 4.5 stars out of 5 for its Medicare Advantage HMO-POS plans.
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Provider portal available to billing partners
By RHONDA LOKKEN, Provider Relations Account Manager
If you partner with a medical billing service or a revenue cycle management company we encourage you to grant access for them to your Security Health Plan provider portal account. The provider portal is where they will find information that is needed for them to process and complete your revenue cycle follow-up. They will be able to obtain needed information more quickly than by phone.
Each provider is the owner of their provider portal account and has a provider portal organization administrator who grants access and oversees the access to their provider portal account. This allows you to restrict the amount of information available to users. Billing service and revenue cycle management employees should be requesting access from your provider portal organization administrator. If you have questions please call Security Health Plan Provider Relations at
715-221-9640.
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Heart Failure Improvement Clinic enriches lives and communities
According to the Centers for Disease Control and Prevention, 5.1 million Americans have heart failure, a chronic disease in which the heart doesn’t pump blood as well as it should. Patients with heart failure often have frequent emergency room visits, hospital admissions, readmissions and high mortality rates.
Marshfield Clinic’s Heart Failure Improvement Clinic (HFIC) was developed to increase survival rates, reduce hospital admissions, improve quality of life and has shown great success.
Learn more
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Project ECHO seeks to reduce opioid-related complications in Wisconsin
From MAKALAH WAGNER, Managed Care Section Chief, Wisconsin Department of Health Services
The Wisconsin Department of Health Services (DHS), Division of Care and Treatment Services, in joint sponsorship with the University of Wisconsin Department of Family Medicine and Community Health, announces the Wisconsin Opioid Project ECHO (Extension for Community Healthcare Outcomes). Project ECHO is a statewide educational, teleECHO initiative that connects clinical experts with primary care providers and medication-assisted treatment prescribers in an effort to reduce opioid-related complications.
Read more
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Stage 3 chronic kidney disease added to CMS risk adjustment model: What you need to know
By ANN MEVERDEN, Revenue Management Educator
Diagnostic coding changes in the 2019 HCC model include the addition of chronic kidney disease (CKD) stage 3.
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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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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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Security Health Plan Makes Changes to Preferred Glucose Monitoring Products
By MATT RICHARDSON, Clinical Pharmacy Services Manager
Effective Jan. 1, 2019, Security Health Plan will be changing our preferred glucose monitoring products. This change allows Security Health Plan to offer high-quality products at a lower overall cost.
Read more
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Security Health Plan enhances home infusion benefits
By AMANDA SIEGLER, Clinical Pharmacy Specialist
Starting Jan. 1, 2019, Security Health Plan will be enhancing our home infusion benefits by increasing the number of medications included under the benefit. The home infusion program offers high-quality care and aids in lowering the total cost of care for our members. This benefit will expand access to home infusion medications and will allow our members the convenience of receiving the infusions in the comfort of their own homes.
Please
check our website for a full list of home infusion eligible medications. Some of the home infusion medications will require prior authorization, which will be managed through our specialty pharmacy medication partner,
Magellan. Security Health Plan is excited to offer this service and the opportunity to expand healthcare options to our members. Please contact our Health Services Department at 800-991-8109 with questions.
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Security Health Plan care team to manage members with rare complex chronic conditions
By TRACY LAPOINTE, Health Services Nurse Manager
Effective Jan. 1, 2019, Security Health Plan’s health services team will take over care management for about 1,200 of our members who have any of 17 rare, complex chronic conditions. We will provide the services previously provided by nurses from AccordantCare
TM
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Access to Part D vaccines improves for Medicare Advantage members
By MARC MEVERDEN, Clinical Pharmacy Services Manager
In 2019, Security Health Plan is not only making it easier for Medicare Advantage Plan members with a Part D benefit to obtain their Part D vaccines, but is offering all Part D vaccines at $0 member cost.
Read more
about this benefit and view our list of common Part B and Part D vaccines for your reference.
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Prior authorization updates
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Medical services prior authorization updates for 2019
By THERESA STERNIK, Health Services Nurse Manager
Security Health Plan requires prior authorization for certain medical services, care or equipment 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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Pharmacy prior authorization and post service claim edits updates for 2019
By AMANDA SIEGLER, Clinical Pharmacy Specialist
Security Health Plan requires prior authorization (PA) or post service claim edits (PSCE) for certain 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.
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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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