Provider Newsbrief
April 2021
Security Health Plan distributes Provider News digitally. Every other month, Provider Newsbrief focuses on policy changes, prior authorizations and other information for providers that is time-sensitive. 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.
COVID-19 update
National Public Health Emergency extended again
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. All indications are the public health emergency could run through at least the end of 2021. Read our updated COVID-19 Provider FAQ for more information.
Check back often to see how Security Health Plan processes help minimize COVID-19 impact on providers
Security Health Plan has developed processes for providers and a webpage to help answer questions about COVID-19 testing and treatment. Access our COVID-19 web page for timely updates. Also see the COVID-19 Provider FAQ for complete information on vaccines, new COVID-19 codes and other questions about testing and treatment.
Policy review
Security Health Plan policy review - Effective April 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 at www.securityhealth.org/providers. Read more for policy reviews and changes effective April 1, 2021.
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.
Security Health Plan updates
Discovery Health Partners to review Security Health Plan claims for appropriate coordination of benefits
By JEFF KEAN, Implementation Manager
Beginning in summer of 2021, Security Health Plan will expand its current partnership with Discovery Health Partners. Discovery will help review Security’s coordination of benefits processes. All product lines will be reviewed. Any claims where a potential recoupment has been identified will result in a letter being sent to the provider. The letter will request either a copy of the primary explanation of benefits or a refund check to reimburse Security Health Plan for its overpayment on the claim(s).
 
Security Health Plan will generate the letters, which will also include the Discovery logo. While not sending physical correspondence, Discovery Health Partners may reach out to provider offices by phone for further information, as necessary. If you have questions, please contact Security’s Coordination of Benefits Department at 1-800-548-4831.
Security Health Plan to expand BadgerCare Plus service area into
Richland and St. Croix counties, effective June 1, 2021
The Wisconsin Department of Heath Services has approved a service area expansion for Security Health Plan's BadgerCare Plus program into Richland and St. Croix counties, effective June 1, 2021. The addition of two counties brings Security's BadgerCare Plus service area to 44 counties in central, northern, western and northwestern Wisconsin.
Security Health Plan to use InterQual 2021 guidelines
Effective July 1, 2021, Security Health Plan will begin to use the InterQual 2021 version for inpatient clinical reviews. All inpatient stays require authorization. Security uses InterQual criteria as a screening tool to determine if the services are clinically indicated and provided in the appropriate level of care. InterQual clinical criteria is based on the principles of evidence-based medicine. The change will impact all of Security’s plans including BadgerCare Plus, individual and family, employer, Medicare and Security Administrative Services.
Prior authorization updates
July 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 July 1, 2021.
Reminders
Reminder of chiropractic coverage changes for Medicare Supplement and Medicare Select plans
As noted in the February 2021 Provider Newsbrief, Security Health Plan has changed the effective date for its chiropractic coverage changes to July 1, 2021. Additionally, effective for dates of service on or after July 1, 2021, Security Health Plan will deny coverage of extraspinal manipulation when billed from any provider type.  Read more
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