Provider News Brief

February 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. 

Policy review

Security Health Plan February 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

Documentation and coding of weight-related diagnoses present challenges to providers

By BRENDA ANDERSON, Revenue Management Educator

International Classification of Diseases-10 (ICD-10) guidelines related to coding Body Mass Index (BMI) and weight diagnoses have changed in the last 5 years. Read more

Updated version of Ombuds brochure available on Security Health Plan website

The Wisconsin Department of Health Services Ombuds brochure is available on our public website. The Ombuds brochure provides guidance for BadgerCare Plus and Supplemental Security Income (SSI) Medicaid HMO members in the event they have a grievance to file.  Read more

New hours coming soon for Security Health Plan provider customer

service department

Security Health Plan’s Provider Customer Service hours will be changing on April 1.

The new hours will be Monday through Friday 8 a.m. – 4:30 p.m. Read more

Security Health Plan and Marshfield Clinic Health System financial contributions enhance Alzheimer's disease research and support

Alzheimer’s is a progressive and fatal disease that devastates people’s families, finances and futures. Thankfully, the Alzheimer’s Association is addressing this global crisis by providing education and support to the millions who face this type of dementia, while advancing critical research toward treatment, prevention and, ultimately, a cure. 

Read more

Security Health Plan commercial members share in cost for monoclonal antibody treatment

Providers are alerted that the costs of monoclonal antibody treatments now apply to cost sharing for members of Security Health Plan’s commercial individual/family and large and small employer group plans. Access our COVID-19 web page for timely updates or click here to go directly to our most recent COVID-19 Provider FAQ.

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

6 p.m. Please call our provider assistance line at 1-800-548-1224 (TTY 711). Read more 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. Click here to a 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 that patients have 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.