Provider News

November 2022

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. 

Policy review

Security Health Plan November 2022 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

naviHealth prior authorization submissions now require additional documentation

By THERESA STERNIK, Clinical Manager, Health Services

Effective Dec. 1, 2022, Security Health Plan will require three patient identifiers for naviHealth prior authorization submissions. These three identifiers must be present on faxed documentation submissions and during telephone submissions. Read more

Bill claims related to Veterans Administration (VA) authorizations to appropriate third-party administrator 

By SHANNA PIECH, Supervisor, Coordination of Benefits

When a patient has a VA authorization, any services related to that authorization should be billed to the appropriate third-party administrator documented on the referral, not Security Health Plan. Read more

Security Health Plan outlines coverage instructions for commercially-purchased monoclonal antibodies 

By APRIL BORES, Manager, Claims Processing Government Programs

For Security Health Plan Commercial plans, any commercially purchased, FDA-approved, monoclonal antibody treatment will be covered subject to the member’s cost sharing according to their benefit plan. Read more

Security Heath Plan requires providers to follow vision stipend guidelines for Medicare Advantage patients

By ASHLEY GURALSKI, Manager, Claims Operations

If you’re a provider contracted to supply routine vision correcting eyeglasses to Security Health Plan Medicare Advantage members who plan to use the yearly stipend, please remember the following guidelines for Medicare Advantage members: Read more

Switching to 102-day supply can help with medication adherence

By MARC MEVERDEN, Manager, Clinical Pharmacy Services

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. Read more

Security Health Plan focuses on improving health equity and inclusion 

Security Health Plan is focused on improving health equity and reducing disparities throughout our service area. That’s why beginning in December, Security Health Plan will ask members for their REAL (race, ethnicity and language) and SOGI (sexual orientation, gender identity) information. Read more

Health equity knowledge minute: Culturally and linguistically appropriate services (CLAS) can improve health outcomes for patients with limited English proficiency

By CHARLES JONES, Program Coordinator, Accreditation and Quality Improvement

The U.S. Department of Health & Human Services (HHS) says following CLAS standards can increase patient safety especially for patients with limited English proficiency.

Read more

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.

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.