Provider News

March 2025

Use Security Health Plan's Provider Portal to verify claims and medical and/or pharmacy prior authorizations

You can check claim status, eligibility, benefits, prior authorization requirements and verify other information on the Security Health Plan Provider Portal at www.securityhealth.org/providers. If you would like more information on how to access the Provider Portal and other Provider Portal resources, click here.

Claims, coding and prior authorizations

How to request home health care authorization extensions

Providers can use Security Health Plan’s secure portal to submit, view the status and see the determination of authorizations. When continued home health services are needed, the initial authorization has ended, or the authorized visits have been utilized, the provider can go into Security Health Plan portal, find the member and the initial authorization, and extend the initial authorization. Never use the Create Service/Procedure Authorization tab to extend authorizations for home health care services.

This home health care authorization extension guide can help you request an extension for a home health care authorization. Read more.

Participating provider prior authorization list

Security Health Plan (SHP) is excited to announce the publication of our first participating provider prior authorization list for each product line. These lists will allow providers to view codes that require prior authorization and/or are considered Experimental/Investigational (E&I) in one location, making authorized/E&I codes more accessible and transparent. Read more.

Post Acute Care Authorizations Changes on the ProAuth Portal

By Theresa Sternik, RN BSN MN CCM

SHP HSD Clinical Manager

In response to feedback from several provider systems regarding the complexity of entering authorizations into the ProAuth system, Security Health Plan has implemented changes to enhance the efficiency of authorization submissions. Read more.

Provider rights and responsibilities - appeals

Effective May 1, 2025, for Medicare Advantage products: providers must appeal within 60 days of the provider statement on which the charge was denied, or partial payment of claims was made. All claims processed on or after 5/1/2025 will follow the 60 day appeal timeframe and any claims processed prior to 5/1/2025 will follow the current 365-day timeframe. There are no changes to commercial or Medicaid products, commercial will remain at 365 days and Medicaid at 60 days. Security Health Plan’s full provider appeal policy can be found at www.securityhealth.org/providerappeal

Policy review

Security Health Plan policy updates

By Karen Borgemoen, RN

Nurse Navigator, Medical Policy Nurse, Team Lead

Security Health Plan reviews medical policies monthly. Our medical policies are in the provider section of Security Health Plan’s public website. Read more.

Security Health Plan updates

Introducing Insite by Security Health Plan

Security Health Plan is excited to announce the rebranding of its third-party administration product from Security Administrative Services to Insite by Security Health Plan. This change underscores our commitment to enhancing our offerings and better serving our clients. Physicians can be assured the rebranding to Insite by Security Health Plan will not affect their current processes or interactions with Security Health Plan. All existing services and commitments to quality care and customer service will remain unchanged. Read more.

Partners in health

Recognizing PTSD symptoms that resemble anxiety disorders

Healthcare providers from different fields often come across patients with anxiety disorders. In fact, almost one in three U.S. adults will experience an anxiety disorder at some point in their life, and one in five will experience it in any given year. [1] Although PTSD is no longer classified as an anxiety disorder, some of its symptoms still resemble those of anxiety. Being aware of the potential for traumatic stress underlying a patient's symptoms can help provide them with the best possible treatment options. Read more.

[1] https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder

Pharmacy

Medicare Vaccine Coverage Part B vs Part D

By Eileen Murphy, PharmD

Director of Pharmacy Services

Vaccines are routinely recommended to help prevent a variety of illnesses. However, obtaining and administering them can be challenging as vaccines are billed per Medicare rules under Part B (medical benefit) vs Part D (pharmacy benefit). Most provider offices are not set up to bill Medicare Part D plans, which can lead to confusion if a vaccine is covered. Security Health Plan has simplified these steps. Read more.

Important information regarding Humira® biosimilars

By Amanda Siegler, PharmD

Clinical Pharmacy Specialist

There are currently a number of Humira® biosimilars available on the market. A biosimilar is a highly similar version of an already approved biologic drug, known as a reference product. Biosimilars are carefully tested for safety and effectiveness to ensure they provide the same treatment benefits as the reference product. Read more.

Changes to commercial formulary effective April 1, 2025

By Amanda Siegler, PharmD

Clinical Pharmacy Specialist

Security Health Plan and MedImpact work diligently to provide appropriate, affordable prescription coverage while managing prescription drug costs. As a result, changes are being made to the commercial formulary (small group, large group, level-funded, self-insured) effective April 1, 2025. Some of these changes are positive tier changes that provide cost savings by adding drugs to the formulary that were excluded (not covered) or moved to a lower tier. Read more.

Security Health Plan Pharmacy and Therapeutics Committee update

By Kurt Wittig, PharmD

Clinical Pharmacy Specialist

At Security Health Plan, our goal is to keep you updated about any changes that may affect Security Health Plan Medicare Advantage members and providers. We want to let you know of the Security Health Plan Pharmacy and Therapeutics Committee approved changes from the January 2025 meeting. This includes changes to medication prior authorization (PA) criteria and Part D formulary placement for some medications. Read more.

Reminders

Quest Analytics' Better Doctor to verify provider directory information

To ensure health plan members have access to accurate, up-to-date provider directory information, Security Health Plan partners with Quest Analytics’ BetterDoctor to collect quarterly provider data attestations for all contracted providers. Read more.

Hospital access payment reports available online

View your hospital access payment reports on the Security Health Plan Provider Portal. Payments are distributed monthly to your practice from Security Health Plan and are based on the number of Medicaid-qualifying inpatient discharges and/or outpatient claims from the prior month for an eligible hospital. Security Health Plan encourages electronic payments (or ACH payments) as they are more secure and cost-effective. Read more.

Security Health Plan requires use of provider portal to submit prior authorization requests

Submit your prior authorization (PA) electronically through the Security Health Plan secure provider portal and receive decisions quicker than the traditional method of faxing or calling in a request. Read more.

ProAuth updates make it easier for provider to view TruCare letters

Security Health Plan recently updated its TruCare and ProAuth to version 10.1.1.0.0. With this new upgrade, your practice can view letters that have been generated via Trucare through the ProAuth tool. Read more.

The Centers for Medicare & Medicaid Services (CMS) requires rate letter for reimbursement of inpatient and outpatient services

Security Health Plan’s reimbursement for critical access hospital, swing bed and rural health clinic’s inpatient and outpatient services is based on their most recent rate letter from CMS. Security Health Plan cannot access facility rate letters and needs to receive them from providers. Read more.

Security Health Plan offers language resource assistance

Security Health Plan providers with patients that require language assistance, the telephone language line is provided free of charge. This line is intended for our contracted providers who do not have access to interpretation services and need to interact with Security Health Plan patients who do not speak English or have limited English language proficiency. Read more.

Provider resources and reminders

Provider feedback and testimonials wanted

Have you had a great experience with Security Health Plan staff that you would like to share? Did they go above and beyond to answer your question, resolve your issue or help your patient get the care they needed? Do you have an idea for a new or enhanced feature for the Security Health Plan Provider Portal or Provider Manual? Are you looking for a better way to access information?

If you answered yes to any of the above, then we would love to hear from you! We want to provide you with the best experience possible and appreciate your input. Click here to submit your feedback. 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, processes and clinical practice guidelines 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 ground floor of the Marshfield Clinic campus 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 (TTY 711). 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?