Provider News

November 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. 

Prior authorization requests for routine services related to a clinical trial for Security Medicaid Managed Care Members 

By ASHLEY GURALSKI, Manager, Government Claims Operations 

In accordance with ForwardHealth guidelines and the HMO Contract, Security Health Plan may require prior authorization for coverage of certain procedures or services associated with a clinical trial. Read more

Reminder: Security Health Plan continues claim edit system enhancements to support correct coding principles 

By LISA PRUST, Provider Contract Specialist

Security Health Plan has payment policies that promote and reflect correct coding and billing guidelines set forth by industry standards. As communicated in the May and Sept. 2023 editions of Provider News, Security Health Plan implemented, and will continue to implement, additional enhancements to claim editing. 

Read more

New eviCore healthcare portal coming for online prior authorization requests 

By JORDAN SKRZECZKOSKI, Provider Relations Account Manager

Effective Dec. 4, 2023, all online prior authorization requests, including radiology and cardiology requests, will need to be submitted on the eviCore healthcare CareCore National portal. Please use your existing credentials to access this portal. 

Read more

Policy review

Security Health Plan November 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 Health Plan's public website. Read more

Pharmacy updates

New update regarding the Magellan portal for medical pharmacy authorizations  

By KURT WITTIG, PharmD, Clinical Pharmacy Services Specialist

Effective, Jan. 1, 2024, Magellan Rx/Prime Therapeutics will require requested authorization duration for Medicare members. In compliance with Medicare Final Rule 4201-F effective Jan. 1, 2024, prior authorization requests for specialty pharmacy medications will require the requester to enter a requested number of days for the authorization duration for the requested drug regimen. Read more

Reminder: Optum acting on behalf of Security Health Plan for bill review 

As we communicated previously, Optum is now acting on behalf of Security Health Plan in facilitating the review of claims pre-payment with an expected reimbursement of greater than $100,000. Optum has been authorized on behalf of Security Health Plan to request, receive and document any medical information, including, but not limited to UB-04’s, itemized charge details and patient medical records. Read more

Reimbursement policy update: Modifier 90-Reference (outside) laboratory  

Security Health Plan requires that the reference lab bill for the service(s) if they are an affiliated laboratory with Security Health Plan. If the Reference Lab is unable to bill for the services or is a non-affiliated provider, then Security Health Plan will accept claims from the referring lab with a 90 modifier. For additional information, refer to the Security Health Plan Provider Manual. Visit Reference Laboratory Billing Protocol for more information.

Security Health Plan is Health Equity Accredited

Security Health Plan of Wisconsin, Inc., received the Health Equity Accreditation for its Medicaid product line from the National Committee for Quality Assurance (NCQA). Read more.

Security Health Plan employee receives patriotic employer award from Department of Defense

The Wisconsin Committee of Employer Support of the Guard and Reserve (ESGR), a Department of Defense program, announced its recognition of Security Health Plan Nurse Manager Laurie Rock on Wednesday, Nov. 9, 2023. Read more.

Security Health Plan CEO named a Wisconsin Titan 100

The Titan 100 organization selected Security Health Plan of Wisconsin Chief Executive Officer, Krista Hoglund, as one of the 2024 Wisconsin Titan 100. The Titan 100 is a national organization that recognizes the top 100 CEOs and C-level executives in a region. Click here.

Commercialization of COVID-19 vaccines will affect billing, coding and payments

While the end of the federal Public Health Emergency did not have an effect on vaccine coverage or availability, it is anticipated that this fall the inventory of federally supplied COVID-19 vaccines will be exhausted. Once this occurs, COVID-19 vaccines will no longer

be provided by the government at no cost and providers will be required to purchase their vaccine supply (i.e., commercialization). 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

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 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, 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.