Provider News

September 2022

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.

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. 

Coding corner

Security Health Plan makes diabetes mellitus HCC coding easier 

By HELEN BROWN, Risk Adjustment Revenue Manager

Diabetes is the most prevalent Hierarchical Condition Category (HCC) chronic diagnosis among Security Health Plan Medicare Advantage members. Documenting and coding the specifics of a patient’s diagnosis is critical to ensure accurate risk factor scores are assigned and the associated revenue will be available to provide care. Read more

Policy review

Security Health Plan September 2022 policy updates

By KAREN BORGEMOEN, Registered Nurse/Team Leader 

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 September 15, 2022.

Security Health Plan joins Labcorp to make preventive care easier for members 

By BECKY SIMMONS, Stars Program Manager

 Security Health Plan and Laboratory Corporation of America Holdings (“Labcorp”) have aligned to assist patients in obtaining preventative health services if they are due for diabetes and/or colorectal cancer screening. Click here

REMINDER: Security Health Plan reimbursement recovery process aids in recovering overpayments 

By LISA PRUST, Account Manager, Payor Strategy and Network Contracting

The reimbursement recovery process allows Security Health Plan to recover overpayments made by Security Health Plan to contracted and non-contracted providers. All verifiable overpayments of a claim by Security Health Plan will be recovered through a recoupment, which is an offset against current claim payments. Read more

Security Health Plan aligns with Medicare coverage on CardioMems™

By CHRISTINE WEIS, Nurse Navigator/Medical Policy Nurse

Security Health Plan is aligning with Medicare coverage to only allow CardioMems when done as part of a clinical trial for Medicare members. The Centers for Medicare and Medicaid Services (CMS) only considers coverage for CardioMems when part of an IDE Study-Category B. IDE studies with this category are approved for coverage of the Category B device, related services and routine services. As a reminder, CardioMems is considered experimental/investigational and/or is not covered for other plans.  

Security Health Plan incorporates national Culturally and Linguistically Appropriate Services (CLAS) into all aspects of consumer and community outreach 

By LESLIE KREMER. Compliance/Privacy Specialist, Senior

Security Health Plan’s mission is to ensure consumers and communities reach their best health. We believe incorporating the National CLAS Standards into our organizational practices and training staff to conduct themselves in culturally and linguistically appropriate ways is a strategic imperative. Click here to read more about Security Health Plan's efforts.

Security Health Plan outlines guidelines for accessibility of services 

By LINDSEY TAUSCHEK, Provider Network Data Integrity Analyst

Security Health Plan’s guidelines for member accessibility of services are found online in the Security Health Plan Provider Manual.

The guidelines explain how quickly members should receive access to medically necessary health care services. It also explains guidelines for a member’s access to see primary care and behavioral health providers. The Security Health Plan Provider Manual can be found here: Security Health Plan Access Standards

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.