Provider News

December 2024

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.

Post-acute care utilization management reviews returning to Security Health Plan

By Karen Borgemoen, Registered Nurse, Nurse Navigator, Medical Policy Nurse Team Lead

Security Health Plan will be transitioning the post-acute care utilization management reviews from Optum Home and Community, formerly naviHealth, back to Security Health Plan starting in December. Read more

New timely filing requirements for BadgerCare Coordination of Benefits claim submission

Security Health Plan is updating its BadgerCare timely filing requirements when coordination of benefits (COB) occurs. To avoid a timely filing denial, providers must submit documentation with the claim demonstrating that claim submission to the other insurer was within Security Health Plan’s filing limit. Read more

Policy review

Security Health Plan December 2024 policy updates

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 updates

2025 Medicare Part D plan updates

By Marc Meverden, Manager, Security Health Plan Pharmacy Services

Part D benefit changes in 2025 include reduced out-of-pocket costs and the Part D "donut hole" finally eliminated. Learn how Part D benefits are changing for 2025, and how Security Health Plan is updating its benefits to help your patients reach their best health. Read more

Update regarding repackaged Avastin

by Amanda Siegler, PharmD, Clinical Pharmacy Specialist

As Pine Pharmaceuticals discontinues production of Avastatin products, it remains an important treatment option for ophthalmology patients. Learn which compounding pharmacies are accepting new provider clients to fulfill orders. Read more

Security Health Plan updates

Important reminder: Medicare Advantage plan portfolio updates

Security Health Plan has refreshed its portfolio of Medicare Advantage plans for 2025, and you may see some new plan names for your Medicare patients who have Security Health Plan. Read more

Important information regarding Esteem Rx vision stipend

Security Health Plan identified an error in the vision stipend benefit for 2024 and 2025 Esteem Rx Medicare Advantage members. Learn how the error is being addressed. Read more

Partners in health

WellBe Senior Medical to offer in-home care to eligible Medicare Advantage members

 Security Health Plan is partnering with WellBe Senior Medical, a leading provider of in-home medical care for seniors. Targeted to start in early 2025, this partnership will bring eligible Medicare Advantage members access to free in-home medical care, 24/7 access to a licensed provider, telemedicine and mental health services. Read more

Reminders

Hospital access payment reports 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 use of provider portal to submit prior authorization requests 

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

ProAuth updates make it easier for provider to view TruCare letters

Security Health Plan recently updated its TruCare and ProAuth to version 10.1.1.0.0. With this new upgrade, your practice can view letters that have been generated via Trucare through the ProAuth tool.  Read more

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

Security Health Plan’s reimbursement for critical access hospital, swing bed and/or rural health clinic’s inpatient and outpatient services is based on their most recent rate letter from CMS. Security Health Plan is not able to access facility rate letters and needs to receive these from providers. Read more

Important update regarding verification of Security Health Plan contracted provider information

Effective January 1, 2025, Security Health Plan is partnering with Quest Analytics’ Better Doctor to collect quarterly provider data attestations for all contracted providers. When you receive the request, please take a few minutes to carefully check your information for accuracy and complete any missing details. 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 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 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 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 would like 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 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, 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.