Provider News

October 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. 

New eviCore healthcare portal coming soon for online prior authorization requests on radiology and cardiology services  

By JORDAN SKRZECZKOSKI, Provider Relations Account Manager

eviCore healthcare currently maintains prior authorization management on two portal platforms:

1. MedSolutions (radiology and cardiology requests) and

2. CareCore National (e.g., requests for outpatient therapy, pain injections, spine and joint surgeries, radiation therapy,

and sleep). Read more

Reminder: Security Health Plan requires CMS rate letter for some Medicare reimbursement methodologies 

By LISA PRUST, Provider Contract Specialist

Security Health Plan’s Medicare Advantage reimbursement for critical access hospital, swing bed and/or rural health clinic’s inpatient and outpatient services is based on their most recent Centers for Medicare and Medicaid Services (CMS) rate letter.

Read more

Policy review

Security Health Plan October 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 updates to prior authorizations and post-service claim edits coming in 2024 

By AMANDA SIEGLER, PharmD, Clinical Pharmacy Services Specialist

Security Health Plan requires prior authorization (PA) and post-service claim edits (PSCE) on medications to ensure coverage and payment for those services. New requirements have been added for 2024 as we work to make sure all care, services and treatments are medically necessary. Read more

Security Health Plan’s Medicare Advantage HMO-POS plans earn 4 stars from the Centers for Medicare and Medicaid Services 

The Centers for Medicare and Medicaid Services (CMS) released its ratings recently and Security Health Plan earned 4 stars for our Medicare Advantage HMO-POS plans. The rating reflects a collaborative effort between Security Health Plan and our network provider partner groups to bring our members high-quality primary and specialized care.  Read more

Updates to Security Health Plan bill review 

By ASHLEY GURALSKI, Manager, Government Claims Operations 

Please be advised Optum will be acting on behalf of Security Health Plan in facilitating the review of claims pre-payment with an expected reimbursement of greater than $100,000. On Security Health Plan’s behalf, Optum has been authorized 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

Reminder: Please review Security Health Plan provider access and availability standards

Security Health Plan has set standards for affiliated providers/practices to ensure Security members have access to afterhours care and access to medical appointments within a certain timeframe. The standards can be found below and also in the Security Health Plan Provider Manual Security Health Plan Access Standards. Security Health Plan conducts annual audits to ensure 100% compliance with these standards. Please take time to review and ensure you are compliant. Read more

Security care managers request notice of all Medicaid member referrals to skilled nursing facilities

By SHERRI WINER, Healthy Services Nurse Manager 

Security Health Plan BadgerCare and SSI members may use any skilled nursing facility located in Wisconsin that is Medicaid-certified. Partnering with skilled nursing facilities for care coordination of our Security Health Plan BadgerCare and SSI members is beneficial in assisting our members and families get the right care, at the right time and the right place. Read more

Updated Medicaid guidelines outlined for behavioral health or AODA services delivered by qualified treatment trainees 

By MARILYN LEZOTTE, Claims Special Investigator 

Security Health Plan requires proper documentation and billing requirements for behavioral health or Alcohol and Other Drug Abuse (AODA) services provided by a qualified treatment trainee (QTT). There are two types of QTTs: Read more

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.