Provider Newsbrief
August 2021
Security Health Plan distributes Provider News digitally. 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.
COVID-19 update
National Public Health Emergency extended
Many Security Health Plan policies and coverages related to the COVID-19 pandemic are in effect until the end of the National Public Health Emergency. All indications are the public health emergency could run through at least the end of 2021. Read our updated COVID-19 Provider FAQ for more information.
Check back often to see how Security Health Plan processes help minimize COVID-19 impact on providers
Security Health Plan has developed processes for providers and a webpage to help answer questions about COVID-19 testing and treatment. Access our COVID-19 web page for timely updates. Also see the COVID-19 Provider FAQ for complete information on vaccines, new COVID-19 codes and other questions about testing and treatment.
Policy review
Security Health Plan policy review - Effective August 2021
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 at www.securityhealth.org/providers. Read more for policy reviews and changes effective August 1, 2021.
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.
Security Health Plan updates
Ascension providers removed from Security Health Plan’s online provider search for three narrow network plans
By ROBYN SCHINDLER, Provider Relations Account Manager
Due to the acquisition by Aspirus Health of the Ascension North Region providers, Ascension providers will no longer be listed in Security Health Plan’s online provider search for three narrow network plans, effective Sept. 1, 2021. This change affects members of Security Health Plan's "Select" individual and family plan, "Reliance" small employer plan and "Discover" large employer plan.
 
The Ascension North Region providers fall under the Aspirus Network Inc. organization as of August 1, 2021. Security Health Plan members in these plans can continue to see Ascension North Region providers through Dec. 31, 2021. Starting Jan. 1, 2022, affected members will need to transition to participating providers within their network. These members will not be covered if they continue receiving services with these Aspirus (formerly Ascension) providers, with the exception of emergency and urgent care or with prior approval from Security Health Plan. 
Enhanced home infusion benefit offers increased number of medications
By APRIL BORES, Manager - Claims Processing Government Programs
Providers are reminded that Security Health Plan has an enhanced home infusion benefit offering an increased number of medications eligible for home administration when received from an affiliated home infusion provider. The home infusion program not only offers high-quality care but also aids in lowering the total cost of care for our members with plans that are eligible (NOTE: Medicaid, Medicare Medical Savings Account, Medicare Supplement and Family Health Center plans are excluded). Read more
Medicaid: Electronic Visit Verification (EVV) Hard Launch Timeline      
Consistent with ForwardHealth Update 2021-23 for dates of service on or after Jan. 1, 2022, Security Health Plan Medicaid will require a valid electronic visit verification (EVV) to be on file for Medicaid-covered personal care services and certain supportive home care services. 

EVV has been required since Nov. 2, 2020, utilizing a soft launch phase to allow providers time to implement any necessary system changes without resulting in claim denials. Services on or after the hard launch date will be denied upon claim submission for services without a valid EVV on file. For more details on EVV refer to Security Health Plan’s Provider Manual page linked here: Personal Care Services/Electronic Visit Verification (EVV). 
Prior authorization updates
Security Health Plan to use InterQual (IQ) criteria for prior authorization of surgical procedures
By KAREN BORGEMOEN, Nurse Navigator/Medical Policy Nurse
Security Health Plan is moving to InterQual (IQ) criteria for our surgical procedures for the Commercial and Security Administrative Services products. It will also be used for Medicare and Medicaid products if they do not have criteria for the specific procedure. The Medical Polices will indicate the criteria that will be used. InterQual is an evidence based clinical decision support tool that is nationally accepted. The process for requested authorization will not change. 
Reminder: Magellan Rx JW modifier used for reimbursement of discarded drugs and biologicals
By APRIL BORES, Manager - Claims Processing Government Programs
As a reminder, Magellan Rx includes vial size in the calculation of the amount eligible for payment in the approvals for the prior authorization program. This means that the units approved in the authorization already include any potential drug waste for each administration.

Example: Remicade
  • Available in 100mg vials
  • If a provider requests 520mg doses, there will be 80mg of waste billable under the JW modifier.
  • Billing should not exceed 600mg per dose or the excess units per administration will be denied.

The JW modifier should be used on claims to submit for reimbursement of the discarded drugs and biologicals. Any waste should be billed on a separate line from the administered drug amount with the JW modifier. Please contact Magellan Rx at
800-424-8243 with any questions. 
October 2021 updates to prior authorizations and post service claim edits
By AMANDA SIEGLER, Clinical Pharmacy Specialist
This is an update to the previously published list for prior authorizations (PA) going live on Oct. 1, 2021, for medical pharmacy. LUMAKRAS® (SOTORASIB) will not require PA on the medical benefit as this drug is available via the pharmacy benefit. PA will be required for this drug on the pharmacy benefit.  Read more
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