Provider News

September 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. 

“Other Insurance” information on file with Security Health Plan may not be on ForwardHealth portal

By SHANNA L. PIECH, C.P.C., Coordination of Benefits Supervisor

In 2019, Security Health Plan partnered with CAQH’s COB Smart Solution to assist in identifying other insurance overlaps for our members. Security Health Plan evaluates the information provided by this tool before loading other insurance to our claim processing system. Read more

Reminder regarding claim edits to enhance claim edit efficiency

Security Health Plan has payment policies that reflect guidelines set forth by industry standards. Our goal is to process claims consistently and in accordance with best practice standards. As communicated in our May 2023 Provider Newsletter, Security Health Plan has implemented additional enhancements to our claims editing programs that promote correct coding and billing practices. Read more

Policy review

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

Pharmacy updates

New drugs added to Medicare Part B step therapy program 

By KURT WITTIG, PharmD, Clinical Pharmacy Services Specialist

For dates of service on or after Jan. 1, 2024, the following drugs will be added to the Medicare Part B step therapy program. In-scope indications include all medically accepted indications unless otherwise noted in the table below. These step therapy requirements apply to commercial lines of business as well as Medicare. Read more

Updates to employer group and ACA formularies 

By AMANDA SIEGLER, PharmD, Clinical Pharmacy Services Specialist

Security Health Plan may add rules about whether and when certain drugs are covered during the year. Your patients may not currently be using these products, but we want to provide you with these updates to alert you of any future changes.  Read more

NCQA names Security Health Plan as one of the highest-rated health plans in Wisconsin and nationwide

Security Health Plan is one of five Medicare plans in Wisconsin to receive an overall rating of 4.5 out of 5 by the National Committee for Quality Assurance (NCQA) Medicare Health Plan Ratings 2023. The annual Health Plan Ratings evaluate Commercial, Medicare and Medicaid health plans in Wisconsin and nationwide. Security Health Plan once again rated high for its Commercial and Medicaid plans as well. Read more

Security Health Plan outlines guidelines for accessibility of services

By AMBER BERNARDE, Provider Contract Specialist

Security Health Plan’s guidelines for member accessibility of services are found online in the Security Health Plan Provider Manual. The guidelines explain how quickly members should receive access to medically necessary health care services. It also explains guidelines for a member’s access to see primary care and behavioral health providers. The Security Health Plan Provider Manual can be found here: Security Health Plan Access Standards

Commercialization of COVID-19 vaccines will affect billing, coding and payments

While the end of the federal Public Health Emergency did not have an effect on vaccine coverage or availability, it is anticipated that this fall the inventory of federally supplied COVID-19 vaccines will be exhausted. Once this occurs, COVID-19 vaccines will no longer

be provided by the government at no cost and providers will be required to purchase their vaccine supply (i.e., commercialization). 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

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.