Provider News

August 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. 

eviCore updates clinical collection process for physical and occupational therapy prior authorizations 

By THERESA STERNIK, Manager, Health Services

As of Aug. 1, 2023, eviCore healthcare is updating its clinical collection process for prior authorizations related to medically necessary physical therapy (PT) and occupational therapy (OT) services following musculoskeletal (MSK) surgery. Read more

Vascular disease remains top category for coding gaps

By BRENDA ANDERSON, Revenue Management Educator

Vascular Disease has consistently been Security Health Plan’s category with the most open Hierarchical Condition Category Coding HCC gaps compared to other categories at the end of each calendar year. Read more

Security Health Plan adds Cotiviti to enhance claim edit efficiency

Security Health Plan has collaborated with Cotiviti as a second pass editing vendor to apply additional enhancements to the current claims editing systems. The new partnership features an automated front end adjudication of claims edits. Read more

Policy review

Security Health Plan August 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

Pharmacy updates

New Security Health Plan updates to commercial and exchange formulary 

By ANDREA SEDLACEK, Clinical Pharmacy Services Specialist

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

New changes to bundled service of Medtronic IN.PACT

Effective Oct. 2023, the Medtronic IN.PACT Admiral Paclitaxel-coated Percutaneous Transluminal Angioplasty (PTA) Balloon Catheter (Medtronic DCB) used as a drug-coated balloon to re-open blocked or narrowed arteries in the thigh and knee due to peripheral artery disease (PAD) will not be separately payable. Read more

Security Health Plan brings in AdhereHealth to help members with medication adherence

A person’s quality of life is affected by their medications, health care treatments and daily living. Some members have challenges that impact their ability to take medications as prescribed. They may also have challenges with obtaining healthy food, maintaining social connections and access to transportation. Read more

Security Health Plan and Freespira offer relief for patients with panic attacks and PTSD symptoms

Patients who experience traumatic flashbacks, sleep disturbances or anxiety attacks may benefit from Freespira. Freespira is an at-home FDA-cleared medical device used to reduce or eliminate panic attacks and traumatic stress symptoms in 28 days. The treatment can be used alongside traditional medication or counseling therapies. Read more

Commercialization of COVID-19 vaccines will affect billing, coding and payments

While the end of the federal Public Health Emergency did not have an effect on vaccine coverage or availability, it is anticipated that this fall the inventory of federally supplied COVID-19 vaccines will be exhausted. Once this occurs, COVID-19 vaccines will no longer

be provided by the Government at no cost and providers will be required to purchase their vaccine supply (i.e., commercialization). 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.