Provider News
April 2019 Clarifications
Please read below and follow the links for clarification of two articles from the April 2019 Provider News. The first clarifies that Northwood, Inc., will continue to provide authorization for positive airway pressure (PAP) devices and supplies for your patients who are members of Security Health Plan. The second clarifies that 2013 dates of service are being requested from providers for the CON14 RADV audit.
Prior authorization updates
CLARIFICATION: Prior authorization for sleep management services to be split between eviCore and Northwood
By THERESA STRENIK, Health Services Nurse Manager
Effective for dates of service starting July 1, 2019, cardiac imaging and most sleep management services for Security Health Plan members will be authorized by eviCore healthcare . Positive airway pressure (PAP) devices and supplies, however, will continue to be authorized through Northwood, Inc. Prior authorization services are required for patients enrolled in Security Health Plan’s Commercial, BadgerCare Plus, Medicare Advantage and Security Administrative Services plans.   Read more
Coding corner
CLARIFICATION: Security Health Plan selected for CON14 RADV audit covering 2013 dates of service
By HELEN BROWN, Risk Adjustment Revenue Manager
Security Health Plan has been selected for a Medicare Part C Contract-Level Risk Adjustment Data Validation (CON14 RADV) audit of 2013 dates of service. This audit is a CMS requirement due to Security Health Plan’s participation in the risk adjustment process for our Medicare Advantage contracts.
Providers play a significant role in the risk adjustment program. Complete and accurate documentation of diagnoses by providers is key to the success of risk adjustment.
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