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 is expected to run through at least the end of 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.
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Eau Claire woman kicks the habit after 50 years with help from Security Health Plan health coach
When a doctor told Lisa she was one of very few patients he knows that smoked cigarettes for as long as she had and didn’t need to use supplemental oxygen to live, Lisa took note. After smoking for over 50 years, the message sunk in and she knew it was time to quit. However, quitting was much easier said than done. Lisa tried quitting numerous times over the past five decades, but was never successful – until now. With support from her doctor, personal determination and support from Angie (pictured), her Security Health Plan health coach, Lisa smoked her last cigarette on March 22, 2021. While Lisa did the work, she credits Angie for helping her succeed. Read more
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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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Documenting and coding Diabetes Mellitus and its complications
By BRENDA ANDERSON, Revenue Management Educator
More than 10,000 Security Health Plan Medicare Advantage (MA) members have Diabetes Mellitus, making it the most prevalent condition affecting the Plan’s MA population. A large number of these members have at least one complication associated with the diagnosis. In order to capture the complexity of their illness, these complications must be documented thoroughly and coded accurately. Read more
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Security Health Plan policy review - effective July 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 July 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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New administrative policy for genetic and molecular testing
By LISA PRUST, Provider Relations Account Manager
As increases in genetic and molecular testing continue, Security Health Plan is committed to improving the sustainability of care by ensuring high-quality, appropriate care is delivered at a fair price. Effective Oct. 1, 2021, Security Health Plan will expand the requirements for billing of genetic and molecular testing.
In accordance with the new Security Health Plan administrative policy for Genetic and Molecular Lab Testing, all providers billing for genetic and molecular testing services will be required to adhere to the coding recommendations from Concert Genetics, our industry-leading genetic testing technology partner. Please click on the following link for detailed information regarding this new policy. Review new policy
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Wisconsin DHS gives Medicaid patients the right to file appeals, grievances
By LINDSEY TAUSCHEK, Provider Network Data Integrity Analyst
Wisconsin Department of Health Services (DHS) allows Medicaid members the right to file an appeal for services provided by their BadgerCare Plus HMO. DHS also allows Medicaid members the right to file a grievance for all non-benefit related concerns. Security Health Plan provides its affiliated Security Health Plan BadgerCare providers with the information detailing the grievance and appeals requirements. Read more
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Prior authorization updates |
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October 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 Oct. 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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