Provider News

January 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. 

Policy review

Security Health Plan January 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 Plan's public website. Read more

New 2023 eviCore prior authorization updates for pain management

By THERESA STERNIK, Clinical Manager, Health Services

Effective Jan. 1, 2023, eviCore will not be requiring prior authorizations for several pain management codes. Read more

Security Health Plan releases new 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 in order to ensure coverage and payment for those services. Read more

Shared Decision Making process helps ETF members consider intervention options for low back pain

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

The Shared Decision Making (SDM) process provides important information for Wisconsin Department of Employee Trust Funds (ETF) members seeking surgery for low back pain. Security Health Plan offers SDM to members as part of the prior authorization process for lower back surgery. Read more

New medications added to Security Health Plan's 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. Read more

Inflation Reduction Act limits cost sharing for Part B drugs and insulin

Two provisions in the Inflation Reduction Act enacted in August 2022 will limit cost sharing for your Medicare Advantage patients who receive Part B drugs and insulin. 

Read more

Switching to 102-day supply can help with medication adherence

Since Jan. 1, 2022, 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. The extended supply of medications can be filled at network retail pharmacies or via mail order pharmacy services. Switching a patient’s prescription to a greater day supply has been shown to increase medication adherence.1, 2

Read more

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

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. Read more

Health equity, language access and cultural competency contribute to a patient’s overall health care

By CHARLES JONES, Program Coordinator, Accreditation and Quality Improvement

Members who are not proficient in English are less likely to get needed health care because of limited language access. To improve individual and community-wide health, it’s important to recognize and address the unique culture, language and health literacy of its diverse population. Read more

Security Health Plan care managers provide targeted care to dual-eligible members

By SHERRI WINER, Health Services Clinical Manager

Security Health Plan’s Ally Rx D-SNP plan delivers coordinated care and care management to members eligible for both Medicare and full benefit Medicaid. The Ally Rx D-SNP Model of Care (MOC) provides a framework for the D-SNP care management team to meet the needs of each of its enrolled members. Read more

Security Health Plan commercial members share in cost for monoclonal antibody treatment

Providers are alerted that the costs of monoclonal antibody treatments now apply to cost sharing for members of Security Health Plan’s commercial individual/family and large and small employer group plans. Access our COVID-19 web page for timely updates or click here to go directly to our most recent COVID-19 Provider FAQ.

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

6 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.



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. Read ,

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

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.