Provider
Newsbrief
October 2019
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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.
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.
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Security Health Plan policy review - September through November 2019
By CHRISTINE WEIS, 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 Sept. 1, Oct. 1 and Nov. 1, 2020.
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Security Health Plan updates
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CMS to implement new home health payment model
Jan. 1, 2020
By JENNIFER DENNEE,
Government Policy and Reimbursement Specialist
Effective Jan. 1, 2020, the Centers for Medicare and Medicaid Services (CMS) will be implementing a new Home Health Patient-Driven Groupings Model (PDGM). The PDGM is a new payment model for the Home Health Prospective Payment System (HH PPS).
Read more
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Telehealth service coverage expands in 2020 for Medicare Advantage plans
By JENNIFER DENNEE,
Government Policy and Reimbursement Specialist
Effective Jan. 1, 2020, the Centers for Medicare & Medicaid Services (CMS) is eliminating
standard fee-for-service restrictions on telehealth access for Medicare Advantage plans (not including our Secure Saver MSA plan). In an effort to increase virtual care choices and benefits, Security Health Plan Medicare Advantage members will have additional telehealth and virtual care benefits beyond Original Medicare. This includes greater access to telehealth services in both rural and urban areas, even in their own home.
Read more
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Family Health Center will no longer cover outpatient surgical services
By KAREN BORGEMOEN, Nurse Navigator/Medical Policy Nurse
Effective Jan. 1, 2020, Family Health Center of Marshfield, Inc., (FHC) will no longer be able to provide financial assistance for outpatient surgical services.
Read more
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Prior authorization updates
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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 for 2020 as we work to make sure all care, services and treatments are medically necessary.
Read more
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Oncology biosimilars and other pharmacy preference/prior authorization updates for Jan. 1, 2020
By AMANDA SIEGLER, Clinical Pharmacy Specialist
Beginning Jan. 1, 2020, Security Health Plan will have several prior authorization updates to select oncology and other medications. Similar to generics, biosimilars create competition and are priced at a discount to the reference product. Since many patients pay a portion or all of a medical expense out of pocket, biosimilars represent an opportunity to lower the overall cost of care and direct savings for our patients.
Read more
for the list of preferred medications.
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January 2020 updates to medication prior authorizations and post service claim edits
By AMANDA SIEGLER,
Clinical Pharmacy Specialist
Security Health Plan requires prior authorization (PA) or post service claim edits (PSCE) for certain 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
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Important online information is a click away
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