Provider News

June 2026

SUPPORT Act Survey closes June 19

As part of a requirement from the Wisconsin Department of Health Services, Security Health Plan must ensure that age-appropriate behavioral health screening and assessment tools are used for Medicaid patients aged 18 and under in primary care settings.  Read more.

Understanding the Health Outcomes Survey

By Becky Simmons, MBA-HCM, BSN, RN

Manager of Quality and Stars



The HOS measures physical and mental health outcomes over a two-year period, focusing on key areas such as physical functioning, mental health, chronic condition management, health risks and behaviors and patient experience. These metrics are essential for determining the CMS Star Ratings for MA plans, which impact reimbursement rates and the plan's attractiveness to potential beneficiaries. Read more.

Security Health Plan recognized nationally for exceptional service

Security Health Plan is pleased to announce their customer service team has earned several national awards from the Service Quality Management (SQM) Group, one of the most respected customer experience research firms in North America. Read more.

Security Health Plan earns NCQA accreditation

Security Health Plan of Wisconsin has been awarded NCQA accreditation across major product lines, including Sanford commercial and Exchange and Security commercial, Exchange, Medicaid and Medicare products.  Read more.

CMS, OIG increase audits of provider claims

By Ashleigh Milleson, RHIA, CRC, CPC

Manager, Risk Adjustment Revenue

The Centers of Medicare and Medicaid Services (CMS) and the Office of the Inspector General (OIG) are increasing audits of patient diagnosis coding on provider claims submitted to health plans. They contend that diagnosis coding on provider claims isn't compliant with the ICD 10 CM guidelines, leading to millions of dollars in overpayment to health plans. Read more for guidance on documentation that supports the conditions coded on provider claims.

EviCore, Eviti authorization revisions and downcoding requests

By Misty Kanta, BSN, RB, CCM

Success Implementation Account Manager

Authorization revisions and facility changes for high-end imaging, cardiac imaging and musculoskeletal procedures must be submitted through EviCore. Radiation Oncology downcoding requests require an updated treatment plan through Eviti. Read more.

Pharmacy

June, July 2026 updates to prior authorizations and post service claim edits

By Amanda Siegler, PharmD, BCACP

Clinical Pharmacy Specialist



Security Health Plan requires prior authorization (PA) and post service claim edits (PSCE) on office-administered, medically billed medications to ensure coverage and appropriate payment for those services. Read more for details on changes occurring to our medical pharmacy program administered by Prime Therapeutics.

Pharmacy prior authorization reminders

By Reed Reuman, PharmD

Manager, Clinical Pharmacy Services



As part of Security Health Plan’s pharmacy benefit manager (PBM) transition from MedImpact to OptumRx, some adjustments were made to formularies and prior authorization requirements. The pharmacy team has been tracking denial trends and would like to highlight the following reminders. Read more.

Reminders

The Centers for Medicare & Medicaid Services (CMS) requires a rate letter for reimbursement of inpatient and outpatient services 

Security Health Plan’s reimbursement for critical access hospitals, swing beds and rural health clinics’ inpatient and outpatient services is based on their most recent rate letter from CMS. Security Health Plan cannot access facility rate letters and needs to receive them from providers. Read more.

All providers are legally required to report suspected child abuse

All providers are legally required to report suspected child abuse and neglect. They must also understand how to report, as well as the laws, identification requirements and reporting procedures involved.

Security Health Plan verifies provider directory information using Quest Analytics’ BetterDoctor 

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

Hospital access payment reports are 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 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.

Security Health Plan encourages the use of the Provider Portal to submit prior authorization requests 

Prior authorization requests are easier and faster with the Security Health Plan provider portal. Submit your request electronically through our secure portal and receive decisions quicker than by faxing or calling in a request.  Read more.

Use Security Health Plan's Provider Portal to verify claims and medical and 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.

Skip the phone queue: visit the provider portal!

Did you know many of your questions can be answered quickly and conveniently through our provider portal? Using the portal helps you avoid phone wait times and gives you 24/7 access to the information you need – on your schedule. Read more.

Updated contact for coordination of benefits questions

By Shanna Piech, C.P.C.

Coordination of Benefits Supervisor

Security Health Plan continues efforts to improve provider experience by directing all provider questions to a single, dedicated provider experience team. Effective March 1, 2026, provider questions related to coordination of benefits should be directed to (800) 548-1224. 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, processes and clinical practice guidelines 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 before 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 regularly 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. CST. 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 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 the 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, patient 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.