Provider News
January 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.
Proud of it
Security Health Plan care managers help members improve, maintain and regain their health
By KAREN TAYLOR, Registered Nurse Care Manager
When your patients reach their optimal level of wellness and functional capability, everyone benefits: the individuals being served, their families and support systems, the health care delivery systems, and the reimbursement sources. At Security Health Plan, our care managers connect with your patients (our members) who are struggling to improve, maintain, or regain their health.   Read more about Security Health Plan care managers. If you have patients who can benefit from our program, please have them call Security Health Plan at 1-888-799-1599 (TTY: 711) to speak with a care manager.
Security Health Plan wellness team offers free programs 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. Read more about Security Health Plan wellness offerings and health coaching. 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.
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
New year brings new HCC coding opportunities
By BRENDA ANDERSON, Revenue Management Educator
As midnight on Jan. 1, 2020, rolled in a new year and decade, your patients' medical profiles were wiped clean from a Hierarchical Condition Category (HCC) coding perspective. The Centers for Medicare and Medicaid Services (CMS) indicates that diagnoses associated with an HCC code must be documented and coded at least once between Jan. 1 and Dec. 31 each year to be considered an active condition for your patient. HCC codes apply a risk factor coefficient, which is necessary for appropriate reimbursement from CMS.   Read more
Dry needling treatment code updates for 2020
By KAREN BORGEMOEN, Nurse Navigator / Medical Policy Nurse
For 2020 there are definitive codes for dry needling:
  • 20560 – Needle insertion(s) without injection(s); 1 or 2 muscles
  • 20561 – Needle insertion(s) without injection(s); 3 or more muscles
When billing for services, use the appropriate codes. Remember to verify if the member has coverage for services.
Policy review
Security Health Plan policy review - January 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 Jan. 1, 2020.
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 adds preferred alternatives to Medicare Part B step therapy program, effective April 1, 2020
By KURT WITTIG, Clinical Pharmacy Specialist
The Centers for Medicare and Medicaid Services (CMS) previously issued guidance that provides Medicare Advantage plans the option of applying step therapy for physician-administered Part B drugs in a way that lowers costs and improves the quality of care for Medicare beneficiaries. For dates of service on or after April 1, 2020, Security is adding preferred alternatives for 15 drugs to the program.   Read more
Expanded National Drug Code requirement for professional and facility outpatient claims goes into effect April 1, 2020
By APRIL BORES, Government Claims Processing Manager
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
Reminders
Security Health Plan provides nutritious benefit for members with CHF after hospital, skilled nursing facility stays
By SHERRI WINER, Health Services Nurse Manager
As of Jan. 1. 2020, Security Health Plan’s Medicare Advantage HMO-POS and Ally Rx D-SNP members who have a diagnosis of congestive heart failure (CHF) receive a nutritious benefit to assist in their recovery. Security has arranged for members to receive two weeks of free meals after they are discharged to home from an inpatient hospital stay or a Medicare-approved stay for recovery following illness or injury in a Medicare-certified skilled nursing facility.  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 your patients have access to accurate, up-to-date information in the Security Health Plan Provider Directory. Security Health Plan is required to attest to the accuracy of its provider network information to various entities including the Wisconsin Department of Health Services, the Wisconsin Office of the Commissioner of Insurance and the Centers for Medicare & Medicaid Services (CMS). Additionally, CMS requires that providers review and update their information quarterly or whenever there is a significant change. T o 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
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
April 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 April 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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