Provider News

August 2025

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.

Claims, coding and prior authorizations

Genicular nerve block will soon require prior authorization

By Christine Weis, BSN, RN, CPC

Appeals and Grievance Medical Policy Nurse

Effective October 1, 2025, genicular nerve blocks will require prior authorization for Commercial and TPA products. Read more.

Support HCC coding with patient DSP

By Brenda Anderson, RN, CPC, CRC

Revenue Management Educator

Provider documentation and coding provide a snapshot of a patient’s health status. Health status is identified by the ICD-10 diagnosis codes entered on provider claims for service. Some providers use diagnosis, status and plan (DSP) to ensure that their documentation supports the ICD-10 codes they enter. Read more.

Drug waste policies to be enforced

By April Bores

Director of Claims

Security Health Plan has been implementing payment policies that reflect guidelines set forth by industry authorities. Our goal is to process claims consistently and per best practice standards. Beginning with claims processed on or after October 1, 2025, for all product lines, we will be instituting two new payment policies for drug wastage. Read more.

Policy review

Security Health Plan July 2025 policy updates

By Christine Weis, BSN, RN, CPC

Appeals and Grievance Medical Policy Nurse

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.

Security Health Plan updates

Sanford, Security Health Plan integration

As part of the new, combined operating structure between Sanford and Security Health Plans, we are integrating our provider relations and other internal teams to align resources, support long-term growth and deliver consistent, high-quality service. Read more.

Vendor partners

Freespira program discontinuation

By Lacey Welke

Director of Care Management

Security Health Plan will discontinue the Freespira program, effective Sept. 1, 2025. While Freespira has provided valuable support to some members, a recent evaluation showed the program did not demonstrate a sustainable return on investment. Read more.

Reminders

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 requires the use of the provider portal to submit prior authorization requests

Submit your prior authorization (PA) electronically through the Security Health Plan secure provider portal and receive decisions more quickly than the traditional method of faxing or calling in a request. 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.

Provider resources and reminders

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. 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?