Provider News

April 2024

Use Provider Portal to verify claims and medical and/or pharmacy prior authorizations

Claim status, eligibility, benefits, prior authorization requirements and other information can be verified on the Security Health Plan Provider Portal at https://www.securityhealth.org/providers. If you would like more information on how to access the Provider Portal and other Provider Portal resources, Click here.

New 2024 updates to prior authorizations and post service claim edits 

By AMANDA SIEGLER, PharmD, Clinical Pharmacy Specialist

Security Health Plan requires prior authorization (PA) and post service claim edits (PSCE) on medications to ensure coverage and payment for those services. Read more

Updated requirement to use Security Provider Portal for claims information

By AMBER BERNARDE, Provider Contract Specialist, Provider Network Management

Effective immediately Security will require all providers to use the Provider Portal as their initial contact to answer questions related to claims. Read more

Policy review

Security Health Plan March 2024 policy updates

By KAREN BORGEMOEN, Registered Nurse/Nurse Navigator/Medical Policy Nurse/Team Lead

Security Health Plan reviews medical policies monthly. You can find our medical policies in the provider section of Security Health Plan’s public website. Read more

Pharmacy updates

Security Health Plan provides enhanced prescription decision support services for all product lines

By EILEEN MURPHY, PharmD, Director of Pharmacy Services

As of April 1, Security Health Plan is using MedImpact’s enhanced e-prescribing platform (MedPrescription Insight™) to provide prescribers with member eligibility, medication history and benefit plan information for ALL Security Health Plan members. Read more

New July update to the Medicare Part B step therapy program

By KURT WITTIG, PharmD, Clinical Pharmacy Specialist

For dates of service on or after July 1, 2024, the following drugs will be added to the Medicare Part B step therapy program: Read more

Utilization management

All cause readmission payment policy for circumvention of prospective payment system

By ASHLEY CUNNINGHAM, Manager, Health Services-Utilization Management

Security Health Plan reviews inpatient admissions that have been identified as a readmission within 30 days for the same or similar diagnosis, illness, injury to the same facility, or another facility that: Read more

Commitment to quality

CAHPS regulatory season is here!

By BECKY SIMMONS, RN-Stars Program Manager

Patient experience is a crucial component of quality care delivery in today's healthcare landscape. The Medicare CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey for health plans, also known as the Medicare Advantage CAHPS (MA CAHPS) survey, is a standardized survey tool used to assess the experiences of Medicare beneficiaries enrolled in Medicare Advantage (MA) plans and Medicare Prescription Drug Plans (Part D). Read more

Security Health Plan partners

Security partners with Curant Health to support members with congestive heart failure  

Nearly 600 of Security Health Plan’s Medicare Advantage members who have a congestive heart failure (CHF) diagnosis have been offered no-cost help to support improved quality of life and effective medication use. Read more

Help seniors overcome common challenges to exercise

We all know exercise is good for us. It helps us live longer, healthier lives. This is especially true for seniors. In fact, it is one of the most important things seniors can do for their health. Read more

Reminders

Reminder: 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

Reminder: 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/or rural health clinic’s inpatient and outpatient services is based on their most recent rate letter from CMS. Security Health Plan is not able to access facility rate letters and needs to receive these from providers. Read more

Security Health Plan and LexisNexis Risk Solutions collaborate to verify provider information

By JORDAN SKRZECZKOSKI, Provider Relations Specialist, Provider Network Management

Security Health Plan is required to attest to the accuracy of its provider network information to various entities including 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 offers language resource assistance

By MONICA SCHMIDT, Provider Relations Specialist, Provider Network Management

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 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 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.