Provider News

May 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 adds Cotiviti to enhance claim edit efficiency

By KATE SCHMUTZER, Provider Network Contract Manager

In quarter four of this year, Security Health Plan will collaborate with Cotiviti as a second pass editing vendor to apply additional enhancements to the current claims editing systems. The new partnership will feature an automated front end adjudication of claims edits. Read more

Policy review

Security Health Plan May 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

Security Health Plan to complete a risk adjustment and validation audit

By BETH KRULL, Product Implementation Manager

Security Health Plan will participate in a risk adjustment data validation (RADV) audit this June. The audit will cover the 2022 benefit year and is part of The Department of Health & Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) annual yearly requirement. Read more

Medicaid unwinding underway: How to help your patients

We shared an update on the Medicaid unwinding in our March issue. The special rules that were put in place during the COVID-19 public health emergency that allowed continuous Medicaid enrollment have come to an end. Read more

Security Health Plan requesting survey responses from providers who see Medicaid patients

As part of a requirement from the Wisconsin Department of Health Services (DHS), Security Health Plan must ensure that age-appropriate behavioral health screening and assessment tools are used for Medicaid patients age 18 and under in primary care settings. In order to meet this requirement, we are asking Medicaid-licensed Med-Peds, Pediatric and Family Medicine providers for help.  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.