Provider News

January 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.

To ensure health plan members have access to accurate, up-to-date provider directory information, Security Health Plan will partner with Quest Analytics’ BetterDoctor to collect quarterly provider data attestations for all contracted providers. Read more

Security Health Plan updates

Sanford Health, Marshfield Clinic Health System officially combine, bringing health plans under one health system

Sanford Health, the largest rural health system in the U.S., headquartered in Sioux Falls, South Dakota, and Marshfield Clinic Health System, have completed their merger and are now one nonprofit integrated health system operating as Sanford Health, marking the beginning of a new chapter for the future of rural health care.

The Marshfield Clinic region is a new health services delivery region of Sanford Health that will continue to serve communities in Wisconsin and Michigan’s Upper Peninsula. This region includes 1,400 providers comprising 170 specialties, 60 clinics, 11 hospitals and a Research Institute. Additionally, each organization’s respective health plans, Sanford Health Plan and Security Health Plan, are now under one health system.

With this change, providers will not experience any immediate changes to their contracts or claims processes. Security Health Plan remains a legal insurer in the state of Wisconsin. Provider contracts remain in place with Security Health Plan of Wisconsin.    Read more

Prior authorization changes

Security Health Plan is changing certain prior authorization requirements beginning January 1, 2025. We’re reducing the number of prior authorizations required for our members. We have thoroughly reviewed all of our medical policies and made the determination to remove a number of codes from prior authorization and in some cases retiring the entire policy. Retired policies will be noted in the monthly Policy Review section of Provider News. Read more

Policy review

Skin substitute changes

Effective Oct.1, 2024, Security Health Plan's Skin Substitute, Chemical Peels, Dermabrasions, and other Skin Procedures Medical Policy had several changes. Read more

Security Health Plan 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 update

April 2025 updates to prior authorizations and post-service claim edits

By Amanda Siegler, Clinical Pharmacy Specialist

Security Health Plan requires prior authorization and post-service claim edits on medications to ensure coverage and payment for those services. A number of requirements have been added for 2025 as we work to make sure all care, services and treatments are medically necessary. Read more

Amanda Siegler

Clinical Pharmacy Specialist

2025 home infusion drug list updates

Effective Jan. 1, 2025, Security Health Plan has revised the list of drugs allowed for administration in the home (home infusion benefit). These are the only drugs covered under the home infusion benefit. Read more

Quality

Becky Simmons Stars Program Manager

Understanding the CMS measure POLY-ACH: A guide for providers

By Becky Simmons, Stars Program Manager



Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (POLY-ACH) is a new Centers for Medicare and Medicaid Services (CMS) star measure starting in measurement year (MY) 2025. Healthcare providers must keep up to date with CMS measures to deliver high-quality care and meet regulatory compliance standards. Read more

Understanding the CMS measure COB: A guide for providers

By Becky Simmons, Stars Program Manager



Concurrent Use of Opioids and Benzodiazepines (COB) is a new Centers for Medicare and Medicaid Services (CMS) star measure starting in measurement year (MY) 2025. As healthcare providers, staying informed about CMS measures is crucial for maintaining high-quality care and ensuring compliance with regulatory standards.  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

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.