Provider News Brief

April 2023

Use Provider Portal to verify claims and medical and/or pharmacy prior authorizations

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. 

Coding corner

Risk adjustment and coding accuracy leads to more accurate payments

By BRENDA ANDERSON, RN, CPC, CRC, Revenue Management Educator

Risk adjustment is a payment model used by the Center for Medicare & Medicaid Services (CMS) to predict the cost of care for health plan members. The model determines the capitated payment from CMS to Security Health Plan based on patient demographics and health status. Read more

New eviCore prior authorization cardiology updates released for 2023 

By THERESA STERNIK, Manager, Health Services Utilization Management

As of July 1, 2023, the following codes related to cardiology will not require prior authorization through eviCore. Read more

Security Health Plan releases new updates to prior authorizations and

post service claim edits

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. New requirements have been added for 2023 as we work to make sure all care, services and treatments are medically necessary. Read more

Policy review

Security Health Plan April 2023 policy updates

By KAREN BORGEMOEN, Registered Nurse/Nurse Navigator/Medical Policy Nurse/Team Lead

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

New Security Health Plan updates to commercial and exchange formulary

By ANDREA SEDLACEK, Pharm D, Clinical Pharmacy Specialist

Security Health Plan may remove drugs from our formulary or add rules about whether and when certain drugs are covered during the year. Your patients may not be currently using these products, but we want to provide you with these updates to alert you of any future changes.  Read more

Switching to 102-day supply can help with medication adherence

By KURT WITTIG, Pharm D, Clinical Pharmacy Specialist

Security Health Medicare Advantage Part D (MA-PD) plan members have been able to get up to a 102-day supply at one time for most prescription drugs as of Jan. 1, 2022. The extended supply of medications can be filled at network retail pharmacies or via mail order pharmacy services. Read more

Security Health Plan Provider Portal features new access to specific information geared to your practice

By JANNEL STAVER, Senior Accountant I

The Provider Portal is a convenient way to access prior authorization forms and status of existing requests, credentialing information and payment information. One of the new features we’ve added includes the ability to view hospital access payments paid to your practice from Security Health Plan. Read more

Security Health Plan to use InterQual 2023 guidelines

Effective May 1, 2023, Security Health Plan will begin to use the InterQual 2023 version for inpatient clinical reviews and procedures. All inpatient stays require authorization. Some procedures also require prior authorization. Read more

Reminder: Critical access hospitals, swing beds and rural health clinics must provide Centers for Medicare & Medicaid Services (CMS) rate letter to Security Health Plan

By LISA PRUST, Provider Contract Specialist

Security Health Plan’s reimbursement for critical access hospital, swing bed and/or rural health clinic’s inpatient and outpatient services is based on their most recent rate letter from CMS. Security Health Plan is not able to access facility rate letters and needs to receive these from providers. Read more

Security Health Plan continues to collaborate with LexisNexis Risk Solutions to verify provider information

Security Health Plan wants to ensure your patients have access to accurate, up-to-date information in the Provider Directory and is required to attest to this accuracy to various entities. To help you meet this requirement, Security Health Plan is continuing efforts with the search firm LexisNexis Risk Solutions. Read more

Reminder: End of COVID-19 public health emergency will affect cost sharing for most Security Health Plan members

The federal government has announced the COVID-19 public health emergency (PHE) will end on Thursday, May 11, 2023. In general, this means members' plan benefits and coverage for COVID-19 services will revert to plan benefits and cost sharing in place prior to the PHE. Read more

Security Health Plan Compliance Toolkit

Click here for details about the FDR Attestation and Security's tools to assist you in meeting your regulatory requirements.

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.

Read more. 

Get monthly Pharmacy formulary updates

Security Health Plan updates its interactive formulary to reflect changes prior to the fifth business day of each month. The Security Health Plan website also contains important information regarding covered medications, tier levels, prior authorization, quantity limits, generic substitution and step therapy. Providers are encouraged to review the Security Health Plan website on a regular basis for the most recent updates. To learn more, visit www.securityhealth.org/prescriptiontools. 

Quality matters to us

Thank you for working with us to keep improving our programs and services for our members, your patients. To find out more about our quality improvement efforts, visit www.securityhealth.org/quality.

Hours of availability

Remember, the hours of availability your practice offers to Medicaid patients must be no less than those offered to commercial patients.

Provider phone line available

If you can’t find your answer on the provider portal, Security Health Plan has staff available to take your calls during business hours, Monday through Friday 8 a.m. to

4:30 p.m. Please call our provider assistance line at 1-800-548-1224 (TTY 711).

Click here to read more about our provider assistance line and other provider resources.



Provider credentialing: Your right to review

Any provider has the right to review his or her credentials record in person at the Credentialing Office during normal business hours. The Credentialing Office is located on the main Marshfield Clinic campus near Urgent Care at 1000 North Oak Avenue, Marshfield, WI 54449. Click here to link to the Provider Credentialing Manual.

Security Health Plan patient coverage review policies

When you and your patients ask Security Health Plan to cover certain medical services, we go through a rigorous review process to ensure our members’ coverage is applied correctly. For more information on our decision-making policies or would like to receive a copy of the criteria used to make coverage decisions, please call Customer Service at

1-800-472-2363 (TTY711). Read more

Your patients’ rights

Patient care involves patient rights and responsibilities. For example, did you know your Security Health Plan patients have the right to know about all treatment choices that are recommended for their condition(s), including the right to request a second opinion, no matter what they cost or whether they are covered by Security Health Plan? And the responsibility to act in a way that supports the care given to other patients and helps ensure the smooth running of their doctor’s office, hospitals and other offices?

Read more

This digital newsletter published by Security Health Plan of Wisconsin, Inc. contains information for care providers, clinic managers, patience assistance, coding and other clinic staff.

If you would like to receive this monthly publication, please create a Provider Portal account. You can contact your organization's administrator to set one up or click here.