Provider News

April 2026

Use Security Health Plan's Provider Portal to verify claims and medical and/or pharmacy prior authorizations

You can check claim status, eligibility, benefits, prior authorization requirements and verify other information on the Security Health Plan Provider Portal at www.securityhealth.org/providers. If you would like more information on how to access the Provider Portal and other Provider Portal resources, click here.

Appeal determination letters now available on the portal

Appeal determination letters are now available directly on the provider portal! This portal enhancement allows you to quickly view and retrieve determination letters on demand, without needing to request them separately.  Read more.

Skip the phone queue: visit the provider portal!

Did you know many of your questions can be answered quickly and conveniently through our provider portal? Using the portal helps you avoid phone wait times and gives you 24/7 access to the information you need – on your schedule. Read more.

Watch for email address changes from Security Health Plan contacts

Over the next few weeks, you may notice some of your familiar Security Health Plan contacts using Sanford Health email addresses. These email addresses end with @sanfordhealth.org. Read more.

Risk Adjustment Data Validation (RADV) audits coming soon

By Brenda Anderson, RN, CPC, CRC

Revenue Management Educator

The Centers for Medicare and Medicaid Services (CMS) has informed health plans nationwide that it will perform multiple contract RADV audits during 2026 and 2027. Read more.

Security Health Plan reinstates Excludes1 note editing

By Ashley Guralski

Claims Manager

Security Health Plan will reinstate Excludes1 note claim editing logic for all claims processed on or after May 1, 2026. This editing will be applied to facility and professional claims for all product lines including Commercia/TPA, Medicare Advantage and Medicaid.  Read more.

Policy review

Security Health Plan March 2026 policy updates

By Karen Borgemoen, BSN, RN

Health Services Team Lead



Security Health Plan reviews medical policies monthly. You can find our medical policies in the provider section of Security Health Plan’s public website. Read more.

Pharmacy

Pharmacy and Therapeutics Committee updates

By Amanda Siegler, PharmD, BCACP

Clinical Pharmacist



The Pharmacy and Therapeutics Committee approved a number of changes at their March 2026 meeting. The list includes changes to medication prior authorization (PA) criteria and commercial/exchange formulary placement for some medications. Read more.

Reminders

Providers are not allowed to improperly bill Medicaid Managed Care Members

Security Health Plan’s provider contract does not allow providers to bill members unless conditions outlined in ForwardHealth Topic #227 have been met.

If Security Health Plan is made aware that a Medicaid Managed Care member has been improperly billed, we will contact your billing office. Providers must agree to remove the balance from the member’s account immediately. If the member has already paid the improperly billed amount, providers must agree to reimburse the member within 60 calendar days of contact with your billing office.

Security Health Plan’s provider experience and provider contracting teams track complaints made against providers for improper billing. If a single pay-to provider has more than 3 complaints logged in a quarter, or 6 in a rolling year, Security Health Plan will begin corrective action; in extreme cases, this could include termination from the health plan.

Please reference Security Health Plan Provider Manual Pages:

• Benefits: Non-covered Services
• Rights & Responsibilities: DHS Subcontractor Requirements between Security Health Plan and Providers/Practices
• Rights & Responsibilities: Improper Billing of Medicaid Managed Care Members (coming soon!)

The Centers for Medicare & Medicaid Services (CMS) requires a rate letter for reimbursement of inpatient and outpatient services 

Security Health Plan’s reimbursement for critical access hospitals, swing beds and rural health clinics’ inpatient and outpatient services is based on their most recent rate letter from CMS. Security Health Plan cannot access facility rate letters and needs to receive them from providers. Read more.

All providers are legally required to report suspected child abuse

All providers are legally required to report suspected child abuse and neglect. They must also understand how to report, as well as the laws, identification requirements and reporting procedures involved.

Security Health Plan verifies provider directory information using Quest Analytics’ BetterDoctor 

To ensure health plan members have access to accurate, up-to-date provider directory information, Security Health Plan partners with Quest Analytics’ BetterDoctor to collect quarterly provider data attestations for all contracted providers. Read more.

Hospital access payment reports are available online

View your hospital access payment reports on the Security Health Plan Provider Portal. Payments are distributed monthly to your practice from Security Health Plan and are based on the number of Medicaid-qualifying inpatient discharges and/or outpatient claims from the prior month for an eligible hospital. Security Health Plan encourages electronic payments (or ACH payments) as they are more secure and cost-effective. Read more.

Security Health Plan offers language resource assistance

Security Health Plan providers with patients that require language assistance, the telephone language line is provided free of charge. This line is intended for our contracted providers who do not have access to interpretation services and need to interact with Security Health Plan patients who do not speak English or have limited English language proficiency. Read more.

Security Health Plan encourages the use of the Provider Portal to submit prior authorization requests 

Prior authorization requests are easier and faster with the Security Health Plan provider portal. Submit your request electronically through our secure portal and receive decisions quicker than by faxing or calling in a request.  Read more.

Updated contact for coordination of benefits questions

By Shanna Piech, C.P.C.

Coordination of Benefits Supervisor

Security Health Plan continues efforts to improve provider experience by directing all provider questions to a single, dedicated provider experience team. Effective March 1, 2026, provider questions related to coordination of benefits should be directed to (800) 548-1224. Read more.

Provider feedback and testimonials wanted

Have you had a great experience with Security Health Plan staff that you would like to share? Did they go above and beyond to answer your question, resolve your issue or help your patient get the care they needed? Do you have an idea for a new or enhanced feature for the Security Health Plan Provider Portal or Provider Manual? Are you looking for a better way to access information? 

If you answered yes to any of the above, then we would love to hear from you! We want to provide you with the best experience possible and appreciate your input. Click here to submit your feedback. 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, processes and clinical practice guidelines 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 before 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 regularly 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. CST. 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 ground floor of the Marshfield Clinic campus 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 to receive a copy of the criteria used to make coverage decisions, please call Customer Service at

1-800-472-2363 (TTY 711). 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.

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?

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.

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 the Provider Relations staff. Call us at 715-221-9640 (TTY 711), fax changes to us at

715-221-9699 or email us at shpprd@securityhealth.org.

This digital newsletter, published by Security Health Plan of Wisconsin, Inc., contains information for care providers, clinic managers, patient 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.