Provider Newsbrief

Security Health Plan covers monoclonal antibody infusions for COVID-19 treatment in accordance with FDA emergency use authorizations. See the COVID-19 Provider FAQ for complete information on these infusions, plus vaccines and new COVID-19 codes.

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, which has been extended to at least Jan. 21, 2021. Read our updated COVID-19 Provider FAQ for more information.

In response to the novel coronavirus (COVID-19) outbreak, Security Health Plan has developed processes for providers and a webpage to help answer questions about testing and treatment. Access our COVID-19 web page for timely updates.

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 Dec. 1, 2020.

You can find important information on services, standards and processes when you visit our Provider and Facility Manuals at www.securityhealth.org/providermanual.

Each year the Department of Health & Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) require Security Health Plan to participate in a risk adjustment data validation (RADV) audit. Due to the COVID-19 pandemic, a RADV audit did not take place in calendar year 2020. CMS will reintroduce RADV activities beginning in January 2021 and will be overseeing two RADV audits during 2021. Security Health Plan is required to participate in both audits. Read more

Beginning Jan. 1, 2021, Security Health Plan will cover home infusion therapy in the member’s home at 100% for drugs listed at www.securityhealth.org/providers/medical-pharmacy. This coverage is generally available only when using providers affiliated with Security Health Plan. The one exception is Medicare Advantage plans, which cover Medicare-covered home infusion therapy at 100% from both affiliated and non-affiliated providers.

Effective for dates of service on or after Jan. 1, 2021, Security Health Plan will deny Medicare covered chiropractic services (98940-98942) that are billed with a GA modifier as patient responsibility when denied by Medicare as such. The GA modifier indicates services billed are maintenance and do not meet Medicare’s medically necessary coverage criteria. Read more

Effective Jan. 1, 2021, prior authorization will not be required for Security Health Plan members who receive occupational therapy or speech therapy when ordered specific to autism or autism spectrum disorder. If either of these therapies are ordered for a member with autism due to another diagnosis (e.g. post-surgery), prior authorization will still be required.