Provider News

October 2022

Use Provider Portal to verify claims information

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 October 2022 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 for policy reviews and changes effective Oct. 15, 2022.

Security Health Plan lists new 2023 updates for prior authorizations and post-service claim edits 

By AMANDA SIEGLER, PHARM D-Clinical Pharmacy Specialist

There are a number of requirements added for 2023 for prior authorizations (PA) and post-service claim edits (PSCE). Security Health Plan requires PA and PSCE on medications in order to ensure coverage and payment for those services. The new requirements are to ensure care, services and treatments are deemed medically necessary.  Read more

Security Health Plan reclassifies the Intracept system as experimental 

By CHRISTINE WEIS, Nurse Navigator-Medical Policy Nurse

The Intracept system or intraosseous basivertebral nerve ablation targets and ablates the basivertebral nerve to provide relief of vertebrogenic chronic lower back pain. Read more

Security Heath Plan adds new drugs to 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. Click here for information on the latest drugs added.

Security Health Plan’s 102-day supply option may help with medication adherence 

Security Health Medicare Advantage Part D (MA-PD) plan members have been able to get up to a 102-day supply at one time for most prescription drugs since January 1, 2022. Network retail pharmacies or mail order pharmacy services are able to fill the extended supply medication prescriptions. Switching a patient’s prescription to a greater day supply has been shown to increase medication adherence. Read more

Security Health Plan collaborates with LexisNexis Risk Solutions to verify provider information

By LINDSEY TAUSCHEK, Provider Network Data Integrity Analyst

Security Health Plan wants to ensure your patients have access to accurate, up-to-date information in the Provider Directory and is required to attest to this accuracy to various entities. These include the Wisconsin Department of Health Services, the Wisconsin Office of the Commissioner of Insurance and the Centers for Medicare & Medicaid Services (CMS). Read more

Security Health Plan continues efforts to incorporate national Culturally and Linguistically Appropriate Services (CLAS) 

Security Health Plan’s strategic initiative to incorporate National CLAS Standards into organizational practices and staff trainings continues with ensuring providers have the knowledge, tools and understanding of CLAS Standards. Please email your Contract Manager or send an email to [email protected] for questions, concerns or comments about Security's CLAS efforts.  

Health Equity Knowledge Minute: CLAS and patient care

By KATE SCHMUTZER, Contracting Manager-MCHS Provider Network

The U.S. Department of Health & Human Services (HHS), says following Culturally and Linguistically Appropriate Services (CLAS) standards improves the quality of services provided to all individuals to achieve health equity and help reduce health disparities. Click here to read more about CLAS and patient care.

Proud of it!

Security Health Plan earns 4.5 stars from CMS for Medicare Advantage HMO-POS plans

We are pleased to announce that Security Health Plan earned an overall rating of 4.5 out of 5 stars from the Centers for Medicare and Medicaid Services (CMS) for our Medicare Advantage HMO-POS plans. Read more

New individual health coverage option provides broad provider network access 

Security Health Plan of Wisconsin, Inc., has a new plan available for people living in 33 Wisconsin counties for 2023 that provides access to an exceptional provider network and includes money-saving perks. Click here for more information about the Premier plan. 

Security Health Plan offers home infusion services for members

By TRACY LAPOINTE, Health Services Clinical Manager

Security Health Plan’s home infusion program offers high-quality care and aids in lowering the total cost of care for our members. This benefit expands access to home infusion medications and allows our members the convenience of receiving infusions in the comfort of their own homes. Read more 

Security Health Plan continues to monitor COVID-19

Access our COVID-19 web page for timely updates or click here to go directly to our most recent COVID-19 Provider FAQ.

First Tier, Downstream and Related Entities (FDR) compliance requirements

Security Health Plan is responsible for fulfilling the terms and conditions of our contracts with the Wisconsin Department of Health Services and/or the Centers for Medicare and Medicaid Services and meeting applicable compliance program requirements.

Security Health Plan requires each practice, as our first tier delegated business partner, to complete an annual Delegated Business Partner Attestation to ensure you are also in compliance with the same compliance program requirements, applicable laws, rules and regulations as our downstream entity. 

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. 

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.