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.
|
|
Check back often to see how Security Health Plan processes help minimize COVID-19 impact on providers
The National Public Health Emergency runs at least through April 20, 2021. Our COVID-19 web page provides information on coverage of the COVID-19 vaccines 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.
|
|
Security Health Plan challenges members to complete 50 Days of Wellness
As part of its 50th anniversary celebration, Security Health Plan is challenging its members to join the 50 Days of Wellness challenge during June and July. Members can track and complete physical and well-being activities to earn points and receive a prize. Activities include daily activities such as packing a healthy lunch, going for a walk, decluttering an area of your home and more. Click on the image at the right to view the 50 Days of Wellness poster and details.
|
|
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.
|
|
Security Health Plan Medicare Advantage condition prevalence and HCC coding
By BRENDA ANDERSON, Revenue Management Educator
Medicare Advantage (MA) beneficiaries are beginning to obtain health care that was delayed during the COVID-19 pandemic. These visits provide opportunity to evaluate and manage your patient’s current and chronic conditions. You will be able to clarify conditions that are active, evaluate for changes in diagnosis specificity and identify complications that have occurred since the patient’s last visit. Managing and coordinating needed care is essential to the patient’s well-being. Read more to see the five most prevalent HCC categories in Security's MA population and the most common diagnoses.
|
|
Security Health Plan policy review - effective May 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 May 1, 2021.
|
|
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.
|
|
Security Health Plan updates |
|
Part B step therapy program changes effective Aug. 1, 2021
By KURT WITTIG, Clinical Pharmacy Specialist
Centers for Medicare and Medicaid Services (CMS) guidance 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. Read more for drugs added to the program for dates of service on or after Aug. 1, 2021. |
|
Nurse On-Call home visit assesses Security Health Plan member needs
By JILL HAMUS, Provider Relations Account Manager
The Nurse On-call program is a one-time targeted home visit to assess the needs of Security Health Plan members identified with safety, home management needs, medication compliance and other care coordination needs. The Nurse On-Call visit can help reduce unnecessary hospitalizations, decrease ER visits, and improve quality of care and cost effectiveness of health care. It can also assist in post-hospitalization management of signs and symptoms, medication management and member questions and concerns about their health management. Read more
|
|
Prior authorization updates |
|
eviCore updates MSK and radiation oncology guidelines
By THERESA STERNIK, Health Services Clinical Manager
eviCore Healthcare will update criteria and guidelines related to certain musculoskeletal (MSK) treatments and procedures, effective July 1, 2021, and to radiation oncology, effective Aug. 1, 2021. eviCore handles prior authorization of these services for Security Health Plan’s BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS and Security Administrative Services plans. Read more
|
|
Carpal tunnel surgery will no longer require prior authorization
By KAREN BORGEMOEN, Nurse Navigator / Medical Policy Nurse
Effective July 1, 2021, Security Health Plan will no longer require prior authorization for its members to receive carpal tunnel surgery. This will apply to Security Health Plan’s BadgerCare, Commercial, Individual & Family Plans, Medicare Advantage and Security Administrative Services.
|
|
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].
|
|
|
|
|
|
|
