Provider News

July 2022

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.

Use Provider Portal to verify claims information

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. 

Coding corner

HCC coding resources help ensure accurate claims 

By BRENDA ANDERSON, RN Revenue Management Educator

Security Health Plan wants to ensure our member, your patient, is accurately portrayed by the documentation and coding you perform when you see your patient face-to-face or via telehealth. Click here for coding resources.

Policy review

Security Health Plan July 2022 policy updates

By KAREN BORGEMOEN, Registered Nurse/Team Leader 

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 for policy reviews and changes effective July 15, 2022.

October 2022 updates to prior authorizations and post service claim edits 

By AMANDA SIEGLER, PharmD, Clinical Pharmacy Specialist 

Security Health Plan (SHP) requires prior authorization (PA) and post service claim edits (PSCE) on medications in order to ensure coverage and payment for those services. Many requirements have been added for 2022 as we work to make sure all care, services and treatments are medically necessary. Click here for more specific drug information.

New drugs added to Security Health Plan’s Medicare Part B step therapy program 

By KURT WITTIG, Clinical Pharmacy Specialist

 The Centers for Medicare and Medicaid Services (CMS) previously  issued guidance that provides Medicare Advantage plans the option of  applying step therapy for physician-administered Part B drugs in a way  that lowers costs and improves the quality of care for Medicare beneficiaries. Click here for details on the drugs being added to the program.

Family Health Center to end coverage of dialysis services 

Family Health Center (FHC) will no longer cover dialysis services with an effective date of service of September 1, 2022. Any FHC member who is currently receiving dialysis services will continue to have coverage for dialysis services through the termination of their current eligibility. Read more

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.

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. 

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.