Provider News

December 2022

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. 

Policy review

Security Health Plan December 2022 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

eviCore releases new PA codes for 2023

By THERESA STERNIK, Clinical Manager, Health Services

Effective Jan. 1, 2023, eviCore is requiring new prior authorization codes for procedures within several specialties including: radiation and radiation oncology, cardiology, spine surgery and pain management. Read more

Diabetes mellitus documentation and coding challenges

By THERESA STERNIK, Clinical Manager, Health Services

Diabetes mellitus (DM) is one of the most prevalent chronic conditions among Security Health Plan’s Medicare Advantage population. The condition is difficult for patients to understand and achieve optimum management. Documenting and coding DM can often pose a challenge. Read more

ETF members required to use Shared Decision Making tool prior to making low back pain provider appointments

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

The State of Wisconsin-Department of Employee Trust Funds (ETF) group will be joining Security Health Plan as of Jan 1, 2023. As required by ETF, members eighteen years of age and older are required to complete Shared Decision Making (SDM) when seeing an orthopedist or neurosurgeon for low back pain. Read more

Genetic and Molecular Testing Reimbursement Policy review details new changes

By LISA PRUST, Account Manager, Provider Relations

In accordance with the Security Health Plan Reimbursement Policy for Genetic and Molecular Test Coding, all providers billing for genetic and molecular testing services are required to adhere to the coding recommendations from Concert Genetics, the industry-leading genetic testing technology partner.  Read more

Security Heath Plan expands Medicaid service area in 2023

Effective Jan. 1, 2023, Security Health Plan will expand its BadgerCare Plus (Medicaid) service area into Florence, Oconto, Door, Brown and Winnebago counties and the Medicaid Supplemental Security Income (SSI) will be available in Vilas, Sawyer, Washburn and Dunn counties.  Read more

Security Health Plan Medicaid Coverage Map 2022 versus 2023: Click here

Health equity knowledge minute: Culturally and linguistically appropriate services (CLAS) and culture

By CHARLES JONES, Program Coordinator, Accreditation and Quality Improvement

Culture is an important consideration in providing care for patients. It has a vast influence on everyone’s lives. It shapes how we perceive health, illness, death, pain, acceptable treatments, and other elements of our lives. Read more

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

6 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.



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. Read ,

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

Security Health Plan continues to monitor COVID-19

Access our COVID-19 web page for timely updates or click here to go directly to our most recent COVID-19 Provider FAQ.

First Tier, Downstream and Related Entities (FDR) compliance requirements

Security Health Plan is responsible for fulfilling the terms and conditions of our contracts with the Wisconsin Department of Health Services and/or the Centers for Medicare and Medicaid Services and meeting applicable compliance program requirements.

Security Health Plan requires each practice, as our first tier delegated business partner, to complete an annual Delegated Business Partner Attestation to ensure you are also in compliance with the same compliance program requirements, applicable laws, rules and regulations as our downstream entity. 

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

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.