Provider News
January 2021
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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.
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Check back often to see how Security Health Plan processes help minimize COVID-19 impact on providers
The National Public Health Emergency has been extended until April 20, 2021. Our COVID-19 web page provides information on coverage of the COVID-19 vaccine and administration as well as treatment. Access our COVID-19 web page for timely updates. Click here to go directly to our most recent COVID-19 Provider FAQ.
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Healthier students, one classroom at a time
Security Health Plan is proud to support the Healthy Classrooms Foundation. This non-profit organization is led by a group of medical students at the University of Wisconsin School of Medicine and Public Health. They incorporate fitness, nutrition, developmental health and environmental responsibility education into primary and secondary schools. The program enables educators to carry out health initiatives that don't have a place in the standard school budget, which makes classrooms healthier places to learn. To learn more about the Healthy Classrooms Foundation, click here.
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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.
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Coding acute stroke and malnutrition
By BRENDA ANDERSON, Revenue Management Educator
A September 2020 report by the U.S. Department of Health and Human Services Office of Inspector General (OIG) indicated that Medicare Advantage organizations had been incorrectly paid millions of dollars for incorrect acute cerebral vascular accident diagnosis coding. In July 2020, OIG reported that hospitals overbilled Medicare $1 billion for inappropriate coding of severe malnutrition on inpatient claims. Read more about what you need to know to avoid these HCC coding errors and associated risks.
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Security Health Plan policy review - effective January 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. Read more for policy reviews and changes effective Jan. 1, 2021.
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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.
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.
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Security Health Plan updates |
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Updated Part D hospice form available on Security Health Plan website
The updated CMS Hospice Information for Medicare Part D Plans and a host of other provider forms can be found in the provider document library on the Security Health Plan website. Click here to view the hospice form.
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Prior authorization updates |
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Notification required for changes to services with an approved prior authorization
By ROBYN SCHINDLER, Provider Relations Account Manager
Security Health Plan reminds providers of its notification requirements for changes to services that have received prior authorization. The requirements cover two situations:
- The change notice is required a minimum of 10 days prior to planned services.
- When a change is made intraoperatively during a planned procedure, notice must be provided no later than 72 business hours after the procedure. Read more
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April 2021 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 2021 as we work to make sure all care, services and treatments are medically necessary. Read more for PA and PSCE updates effective April 1, 2021.
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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?
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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.
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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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