Provider Newsbrief
December 2019
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.

Every other month, Provider Newsbrief focuses on policy changes, prior authorizations and other information for providers that is time-sensitive.

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.
Policy review
Security Health Plan policy review - December 2019 
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 Dec. 1, 2019.
Security Health Plan updates
Security Health Plan to update billing guidelines for infusion chemotherapy
By SARA WEIX, Durable Medical Liaison
Effective for dates of service beginning Feb. 1, 2020, Security Health Plan will update existing billing guidelines regarding infusion chemotherapy initiated in the provider’s office and completed in the patient’s home. For this type of service, external infusion pumps or other supplies dispensed in the provider’s office are not separately billable or reimbursable as durable medical equipment.
Click below for the office infusion protocol in the Security Health Plan Provider Manual:
New Wisconsin step therapy law goes into effect for 2020
By AMANDA SIEGLER, Clinical Pharmacy Specialist  
Effective for dates of service on or after Jan. 1, 2020, a new step therapy law (Wisconsin Act 12) will go into effect in the state of Wisconsin. This law will apply to both prescription and medical pharmacy drugs that have step therapy components. It applies for the following lines of insurance: commercial, federally facilitated exchange, large group, small group, self-insured and Family Health Center.  Read more
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  
Prior authorization updates
Security Health Plan to manage musculoskeletal and therapy prior authorizations for members in seven Security Administrative Services plans
By THERESA STERNIK,  Health Services Nurse Manager  
Effective Jan. 1, 2020, Security Health Plan will manage musculoskeletal procedure and outpatient therapy prior authorizations for members enrolled in the following Security Administrative Services plans, regardless of the rendering provider: Marshfield Clinic Health System employer group, Marshfield Medical Center-Beaver Dam, Abbyland Foods, City of Stevens Point, Marathon Bank, Mid-State Technical College and Simplicity Credit Union.    Read more
CMS shortens turnaround times for Part B drug utilization review and prior authorizations
By AMANDA SIEGLER, Clinical Pharmacy Specialist  
Effective Jan. 1, 2020, the Centers for Medicare and Medicaid Services (CMS) has issued changes to medical drug Part B utilization review turnaround times. R equests for prior authorizations containing all Part B drugs will be shortened to the same turnaround times as currently required for Part D drugs.  Read more
Medical services prior authorization updates for 2020 
By KAREN BORGEMOEN, Nurse Navigator/Medical Policy Nurse
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 as well as removed for 2020 as we work to make sure all care, services and treatments are medically necessary.  Read more
Reminders
Medicare Beneficiary Identifier required starting Jan. 1, 2020
The Centers for Medicare and Medicaid Services (CMS) reminds health plans and providers that the Medicare Beneficiary Identifier (MBI) must be in use starting Jan. 1, 2020. Providers are encouraged to:
  • protect their patients’ identities by using the new MBI
  • direct patients who did not get a new Medicare card to visit MyMedicare.gov or call 1-800-MEDICARE
Provider phone line available 8 a.m. to 6 p.m.
If you can’t find your answer on the provider portal, Security Health Plan has staff available to take your calls during business hours, 8 a.m. to 6 p.m. Please call our provider assistance line at 1-800-548-1224 (TTY 711).

There are times when leaving a voicemail may be necessary. We will return your call within 24 business hours; please allow 24 hours before calling Security Health Plan again. Please avoid making multiple phone calls regarding the same issue. This practice may delay our response time for all.

To help us provide you with efficient service, please provide the following information:
  • Your name
  • The name of your office or clinic (including location, if more than one exists)
  • Reason for your call: member benefits, member eligibility, claim status, etc.
  • Member name or ID number, if in regard to benefits or eligibility
  • Claim number, if in regard to a claim
Quality matters to us
Thank you for working with us to keep improving our programs and services for our members, your patients. Learn more about our quality improvement efforts.
Applying patient coverage
When you and your patients ask Security Health Plan to cover certain medical services, we go through a rigorous review process to ensure our members’ coverage is applied correctly. Security Health Plan does not reward providers or other individuals for denying coverage. Security Health Plan also does not make decisions regarding hiring, promoting or terminating individuals based upon the likelihood, or perceived likelihood, that the individual will support, or tend to support, the denial of benefits. Providers are not encouraged to or financially rewarded for making decisions that result in providing members with fewer medical services. If you have questions about our decision-making policies or would like to receive a copy of the criteria used to make coverage decisions, please call Customer Service at 1-800-472-2363 (TTY 711).
Get monthly formulary updates
Security Health Plan updates its interactive formulary to reflect changes prior to the fifth business day of each month. The Security Health Plan website also contains important information regarding covered medications, tier levels, prior authorization, quantity limits, generic substitution and step therapy. Providers are encouraged to review the Security Health Plan website on a regular basis for the most recent updates. Click here and select a plan type to review the Security Health Plan interactive formulary.
Provider credentialing: Your right to review
Any provider has the right to review his or her credentials record in person at the Credentialing Office during normal business hours. The Credentialing Office is located on the main Marshfield Clinic campus near Urgent Care at 1000 North Oak Avenue, Marshfield, WI 54449. Providers must notify the Credentialing Office of their desire to review their materials at least one business day in advance. Providers also have the right to request a copy of the materials regarding the provider contained in our electronic database.

The provider will not be allowed to review any information that is peer-review-protected – including, but not limited to: references, peer review, quality of care reports and National Provider Data Bank (NPDB) results. Although materials may not be removed or altered (except for factual errors and then only by the Credentialing Office), providers may, at their discretion, write statements of correction or clarification that will also be kept in their credentials record.
Your patients’ rights
Patient care involves patient rights and responsibilities. For example, did you know, your Security Health Plan patients:
  • have the right to know about all treatment choices that are recommended for their condition(s), including the right to request a second opinion, no matter what they cost or whether they are covered by Security Health Plan?
  • have the responsibility to act in a way that supports the care given to other patients and helps the smooth running of their doctor’s office, hospitals and other offices?
Security Health Plan patients’ rights and responsibilities are found in the online Provider Manual by product line, under “Member Information,” then “Member Rights and Responsibilities.” View the Provider Manual
Hours of availability
Remember, the hours of availability your practice offers to Medicaid patients must be no less than those offered to commercial patients.
Important online information is a click away
You can find important information on services, standards and processes when you visit our Provider and Facility Manuals at www.securityhealth.org/providermanual .
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