Provider News
BREAKING NEWS Security releases the first digital edition of Provider News! Don't forget to share with your colleagues. If you wish to receive this bi-monthly newsletter please create a Provider Portal account.
Proud of it
Improving members quality of life
By KRISTEN WINTER
Security Health Plan Care Managers take the time to help members understand their health issues and provider's care plan. See how Cindy Mueller put a member on the path to better health. Read more
Tips and tools
Oncology Care Management program aims to individualize care plans for Security members
By SUE WILHELM
Security now offers an Oncology Care Management program free to our members. Learn more
Consolidated Billing
By CARL ANDERSON
Are you following the Consolidated Billing rules for Medicare Advantage members? Find out more
Changes to the hospital observation admission process
By THERESA STERNIK
Observation care is clinically appropriate services that include ongoing short-term treatment, assessment, and reassessment before a decision can be made regarding further hospital inpatient treatment or discharge from the hospital .
Newly approved biosimilars and updated preferred products
Coding corner
Year-over-year documentation of amputations required for accurate HCC coding
By ANN MEVERDEN
Amputations are permanent, but frequently go unreported year over year. In order to be considered for Centers for Medicare and Medicaid Services (CMS) Risk Adjustment, amputation diagnoses must be documented and coded annually to be captured on claims for services provided to Security Health Plan members.    Keep reading
New codes without a corresponding commercial fee
By KATHY SCHMUTZER
Earlier this year Security Health Plan set fees for codes on its fee schedule where they previously did not exist. This was done using various available data from Fair Health, Centers for Medicare and Medicaid Services and our affiliated providers’ charge data. 

Effective Oct. 1, 2018, when a new code is introduced that does not have a corresponding commercial fee, Security will reimburse providers at 60 percent of their billed charge until data is available to set the fee. In an effort to update the commercial fee schedule in a timely manner, each quarter Security will set a fee for all new codes without a fee that have been billed in the previous quarter.
Provider expertise requested for medical policies and criteria

As Security Health Plan reviews and develops clinical criteria on Medical and Interpretation Policies, we ask providers with particular professional knowledge or clinical expertise on certain subjects for their input and opinions.

Requests from providers must be documented on the Provider Input Form . Please download the form from www.securityhealth.org/medicalpolicies. Then, email the completed form to shp.health.services@securityhealth.org. We appreciate your input.

To receive payment, providers must meet all policy criteria outlined for the specific service provided. Please review the current month’s medical policy updates and/or changes at www.securityhealth.org/medicalpolicies.
Reminders
National Provider Identifier for proper claims processing
By THERESA STERNIK
Claims for physical, occupational and speech therapy billed on a CMS 1500 form should include the rendering provider’s National Provider Identifier (NPI). The rendering provider’s NPI, and taxonomy if applicable, should be entered in box 24J on the CMS 1500. This will ensure proper processing and payment of the services.
Updated prior authorization and post service claim edits
By THERESA STERNIK and AMANDA KLOS
Security Health Plan requires prior authorizations or post service claim edits (PSCE) for certain medical services, care or equipment in order to ensure coverage and payment for those services.
Security updates its policies
By THERESA STERNIK
Review Security Health Plan's policy changes that were made effective June 1, 2018. View changes
Security to use InterQual 2018 guidelines
By THERESA STERNIK
Security Health Plan will use the 2018 InterQual Criteria for medical necessity reviews of elective or urgent admissions for dates of service Aug. 1, 2018, and later. 
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 Provider Relations staff at 715-221-9640 (TTY: 711), fax changes to us at 715-221-9699 or email us at shpprd@securityhealth.org .
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