Provider News

July 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. 

Security Health Plan releases new 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. A number of requirements have been added for 2023 as we work to make sure all care, services and treatments are medically necessary. Read more

Policy review

Security Health Plan July 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

Respiratory panel no longer covered for some members

Effective Oct. 1, 2023, Respiratory Panel Testing, specifically large respiratory panels (e.g., BioFire FilmArray Respiratory Panel) involving six or more targets will no longer be covered for Commercial members. Currently these are non-covered for Medicaid and Medicare. 

Timely provider response required to process Quality of Clinical Care (QCC)* and Quality of Service (QS)** member complaints 

By JORDAN SKRZECZKOSKI, Provider Relations Specialist, Payor Strategy and Network Contracting

Security Health Plan follows a 30-day time frame (start to finish) for processing member complaints as outlined by applicable accreditation and regulatory standards. Security Health Plan’s review of QCC and QS complaints includes provider outreach to assist in investigation and resolution of these member complaints. Read more

Provider portal features easier way to find members’ Coordination of Benefit details 

By SHANNA PIECH, Supervisor, Coordination of Benefits

The Security Health Plan provider portal now provides an easy way to look up Coordination of Benefits details. The provider portal will now display the name of the other insurance Security Health Plan believes is primary for our members. You will also be able to view the primary plans identification number, the eligibility date range for the primary coverage, the group number and group name. Read more

Security Health Plan members can find help with social care needs with a click

As the basics of daily life become more challenging, many people find they need help to address social determinants of health, the personal, family and social care needs that play important roles in determining overall health and well-being. Security Health Plan members, Marshfield Clinic Health System (MCHS) patients and other community members will soon have a new, simple and convenient way to search and connect with professionals who offer support for a wide array of personal and social needs. Read more

Understanding cultural humility with Hmong patients

By CHARLES JONES, Quality Program Coordinator

Understanding and practicing cultural humility allows patients to receive the best possible care. This month introduces the unique cultural needs of Hmong patients and families with an emphasis on cultural humility. Read more

End of COVID-19 public health emergency affects cost sharing for most Security Health Plan members

The COVID-19 public health emergency (PHE) ended on Thursday, May 11, 2023.

In general, this means coverage for COVID-19 related services reverted to plan benefits and cost sharing in place prior to the PHE. 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 main Marshfield Clinic campus near Urgent Care 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 (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

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.