Provider News
March 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.
Security Health Plan develops processes to minimize COVID-19 impact on providers and members
In response to the novel coronavirus (COVID-19) outbreak, Security Health Plan has developed processes for providers and a webpage to help answer its members’ questions about testing and treatment.  Read more
Coronavirus COVID-19 interim policy coverage for telehealth services
Effective immediately, Security Health Plan will cover telehealth services as outlined in its updated Telehealth Medical Policy through 04/30/20. View Telehealth Medical Policy . 

Security Health Plan will be re-assessing and updating this policy as necessary as situations change during the coronavirus COVID-19 pandemic.
 
The coverage outlined in the Telehealth Medical Policy will cover providers who are credentialed and affiliated with Security Health Plan. Telehealth visits will be reimbursed according to the provider’s current Security Health Plan contracted rate. The member’s plan cost sharing will apply. 
 
Providers should bill telehealth services with POS 02 and modifiers GQ, GT, or 95 if applicable. 
Proud of it
Security Health Plan takes care of our communities
Security Health Plan of Wisconsin released the annual review of community investments for 2019-2020: Taking Care: A Community Investment. As a not-for-profit organization, Security Health Plan is focused on helping people and communities achieve their best health. The report highlights many of the ways Security Health Plan achieved that goal in 2019. Read more  
Security Health Plan wellness team offers free programs and resources to help support our members’ health
By ANGIE PERO, Health Educator
Security Health Plan’s wellness team can be your valued partner in helping your patients maintain and improve their health. Health coaching over the phone and helpful health education materials are available free of charge to nearly all of our members to help with weight management, quitting tobacco/nicotine, increasing physical activity, healthy eating, managing stress and more. If you have patients who can benefit from our programs, please have them call Security Health Plan at 1-800-472-2363 (TTY: 711) and ask to speak with a health coach.

March is National Colorectal Cancer Awareness Month, with colon health a focus of our wellness communications to Security Health Plan members. Here are two related articles that could be valuable for your patients who are Security members. Read more
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.  
Coding corner
Coding gaps common with specified heart arrhythmias - hierarchical condition category (HCC) 96
By BRENDA ANDERSON, Revenue Management Educator
HCC 96, Specified Heart Arrhythmias, has become Security Health Plan’s Medicare Advantage HCC category with the most gaps in diagnostic coding when compared to other categories. Most HCC 96 coding gaps occur when your patient’s symptoms are quiescent. If the condition is present but stable with treatment such as medication, cardiac device or other therapy, it is acceptable to document and code for the condition.    Read more


Policy review
Security Health Plan policy review - March 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 March 1, 2020.
Musculoskeletal policies to update on June 1, 2020
By CHRIS WEIS, Nurse Navigator / Medical Policy Nurse
The Security Health Plan musculoskeletal policies for hips, knees and spine are being updated to align with eviCore musculoskeletal polices. Security will begin utilizing these updated musculoskeletal policies on June 1, 2020.
  • Knee Replacement Arthroplasty Policy
  • Knee Surgery - Arthroscopic and Open Procedures Policy
  • Hip Replacement Arthroplasty Policy
  • Hip Surgery - Arthroscopic and Open Procedures Policy
  • Spine Surgery Policy
As these policies are implemented, you can check for updates on the medical policies page of our website: www.securityhealth.org/medicalpolicies.
Security Health Plan to update genetic testing policies
Security Health Plan is in the process of updating its genetic testing policy and separating the policy into categories of genetic testing. Over the next several months these new policies will be created from the current genetic testing policy, which will also include updated criteria. The new policies will be noted in the Provider News. Please watch for the effective date of each policy. Genetic testing continues to require prior authorization unless the test requested states no prior authorization.  
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.

Requests from providers must be documented on the Provider Input Form . Please download the form from www.securityhealth.org/medicalpolicies. Then, email the completed form to [email protected]. We appreciate your input.

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
Security Health Plan Medicare Advantage plans offer coverage for ambulance non-transport
By ASHLEY GURALSKI, Claims Operations Manager
Effective Jan. 1, 2020, Security Health Plan’s Medicare Advantage HMO-POS and Ally Rx D-SNP plans offer coverage for ambulance non-transport (HCPCS code A0998).   Read more
Reminders
Expanded National Drug Code requirement for professional and facility outpatient claims goes into effect April 1, 2020
By APRIL BORES, Government Claims Processing Manager
As a reminder of the article in the January 2020 Provider News, effective for claims with a date of service on or after April 1, 2020, Security Health Plan is expanding the National Drug Code (NDC) requirement for all drug-related codes to both professional and facility outpatient claims for all product lines.  Read more
Assistants at surgery covered when medically necessary
and appropriate
By ROBYN SCHINDLER, Provider Relations Account Manager
Assistants at surgery are covered when an assistant is considered medically necessary and appropriate. Criteria considered include the need for the expertise of another surgeon in a complicated case for decision-making or surgical involvement. Assistants at surgery are reimbursed only as noted in Security Health Plan’s online Provider Manual.  Read more
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 .
For a list of information available at your fingertips in the provider manual, click here
Prior authorization updates
July 2020 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 2020 as we work to make sure all care, services and treatments are medically necessary. Read more for PA and PSCE updates effective July 1, 2020 .
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] .
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