Provider News

March 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. 

Policy review

Security Health Plan March 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

Help your patients lower their prescription drug costs

Healthcare providers can’t be expected to know the cost of every prescription and how

their patients’ health insurance will cover them at the pharmacy. That’s why Security Health Plan is working with Rx Savings Solutions to give our members drug pricing transparency. Read more about how you can help.

New medications added to Security Health Plan's Medicare Part B step therapy program

By KURT WITTIG, Pharm D, 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. Read more

Medicaid unwinding to begin soon; special enrollment period announced

The special rules that were put in place during the COVID-19 public health emergency (PHE) to allow more people to get, and keep, BadgerCare Plus and Medicaid benefits will soon come to an end. Read more. Access our COVID-19 web page for timely updates or click here to go directly to our most recent COVID-19 Provider FAQ.

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

The federal government has announced the COVID-19 public health emergency (PHE) will end on Thursday, May 11, 2023. In general, this means members' plan benefits and coverage for COVID-19 services will revert to plan benefits and cost sharing in place prior to the PHE. Read more.

Security Health Plan helps central Wisconsin volunteers recirculate medical equipment for community members in need

Recovering from an injury or remaining independent in your own home can be difficult without the right medical equipment. Thanks to the Good News Project’s Health Equipment Lending Program (HELP), people in North Central Wisconsin can borrow necessary equipment to stay mobile, safe and independently living in their own homes. Click here to read more about this program.

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.