Provider News

May-June 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.

Hierarchical Condition Category (HCC) coding of chronic kidney disease 

By BRENDA ANDERSON, RN, CPC, CRC, Revenue Management Educator

Chronic kidney disease (CKD) is a prevalent condition in Medicare Advantage (MA) members. It is associated with HCC coding in most risk models. Provider documentation and coding of the specific stage of CKD is imperative to assure proper ICD 10 CM diagnosis code and risk factor co-efficient assignment. Read more

Policy review

Security Health Plan May-June 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

Signed waivers required for services related to experimental/investigational procedures

By LISA PRUST, Provider Contract Specialist

A member cannot be billed for E/I unless a signed waiver is obtained PRIOR to the use of experimental/investigational drug, supplies or procedures. The waiver must include reason why the service is not covered by Security and the amount of patient liability. Read more

Pharmacy updates

Drugs excluded from coverage under the Medicare Part D program

By MARC MEVERDEN, PharmD, Clinical Pharmacy Services Manager

While Security Health Plan tries to make medicines available to patients at a cost they can afford, certain categories of drugs are always excluded from Medicare Part D coverage by federal law. That means your Security Health Medicare Advantage Part D plan does not cover them. Read more

New update to the Medicare Part B step therapy program coming in July

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

ProAuth updates make it easier for provider to view TruCare letters

By THERESA STERNIK, Utilization Manager

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

Risk adjustment data validation audit coming

By PATRICIA KOLBECK, Operations Specialist

Each year, the Department of Health & Human Services (DHHS) and Centers for Medicare and Medicaid Services (CMS) requires Security Health Plan to participate in a risk adjustment data validation (RADV) audit. This year the audit begins in June 2024 for the benefit year 2023. Read more

View hospital access payment reports online

By JANNEL STAVER, Senior Accountant I

You can now log on to the Security Health Plan Provider Portal and view your practice’s hospital access payment reports. These payments are distributed monthly and are based on the number of Medicaid-qualifying inpatient discharges and/or outpatient claims from the prior month for an eligible hospital. Read more

Commitment to quality

The importance of CMS star ratings

By BECKY SIMMONS, RN-Stars Program Manager

The Star Ratings system began in 2007 as a way for the Centers for Medicare and Medicaid Services (CMS) and beneficiaries to assess the performance of Medicare Advantage health plans. Performance is based on measures evaluating evidence-based care, quality of care, and member experience. Read more

Provider input requested for behavioral health screening survey

As part of a requirement from the Wisconsin Department of Health Services (DHS), Security Health Plan must ensure that age-appropriate behavioral health screening and assessment tools are used for Medicaid patients aged 18 and under in primary care settings. We are asking Medicaid-licensed Med-Peds, Pediatric and Family Medicine providers for help to meet this requirement. Read more

Security Health Plan partners

Help improve patients’ access to mental health treatment

Providers can help remove barriers to care for patients needing mental health treatment options. If you have patients who can benefit from treatment, please visit www.freespira.com/provider to learn more about the treatment and the referral process. Read more

Reminders

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

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

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

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.