Provider News

June 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. 

New eviCore prior authorization radiation oncology updates released 

By THERESA STERNIK, Manager, Health Services Utilization Management

As of Oct. 1, 2023, the following codes will not require prior authorization through eviCore. Read more

Policy review

Security Health Plan June 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

Office of the Inspector General adds cancer diagnoses to hierarchical condition category audits

By BRENDA ANDERSON, RN, CPC, CRC, Revenue Management Educator

The Office of the Inspector General (OIG) has now added four cancer diagnoses to the list of diagnoses they are targeting on Hierarchical Condition Categories (HHC) audits. Read more

Important Reminder: EFT and ERA requests must be provided by providers directly

By LISA PRUST, Provider Contract Specialist

Security Health Plan will only accept Electronic Fund Transfer (EFT) or Electronic Remittance Advice (ERA) enrollment/changes directly from a practice/provider. Read more

Providers to receive naviHealth survey to increase efficiency of patients transitioning to skilled nursing facilities

Providers will soon receive naviHealth surveys to gauge efficiency level of patient transfers. The naviHealth Annual Provider Survey is sent to skilled nursing facilities (SNFs) in the Security Health Plan coverage areas to confirm contact information and their clinical capabilities.  Read more

Survey asks Medicare patients to rate providers and health plans

Every year the National Committee for Quality Assurance (NCQA) measures Medicare Advantage (MA) members’ perception of their own health and the quality of care they are provided through the Health Outcomes Survey (HOS). This survey provides NCQA with valid, reliable and clinically meaningful health status data from the MA program to use in quality improvement activities, pay for performance, program oversight, public reporting and to improve health. Read more

Providing culturally responsive care through cultural humility

By CHARLES JONES, Quality Program Coordinator

Providing culturally responsive care can be a challenge, but it can be achieved through cultural humility. Consider watching this 30-minute documentary by San Francisco State University professor Vivian Chávez. It mixes poetry with music, interviews, archival footage, and images of community, nature and dance to explain what cultural humility is and why we need it. Read more

Cultural humility: the Hispanic population 

It is important to recognize and embrace cultural diversity when caring for patients.

This is especially true when caring for Hispanic populations, as they represent a significant and growing demographic in our service areas and throughout the United States. 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.