Provider News

September 2024

Use Security Health Plan's Provider Portal to verify claims and medical and/or pharmacy prior authorizations

You can check claim status, eligibility, benefits, prior authorization requirements and verify other information 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.

Security Health Plan switching to InterQual^® Transparency Tool for medical decision-making

By THERESA STERNIK, Manager, Health Services-Utilization Management

Security Health Plan will now be using the InterQual^® Transparency Tool to aid in the medical decision-making process. InterQual^® products cover the continuum of medical care and provide enhanced clinical detail which allows for consideration of an individual patient's severity of illness, comorbidities and complications in the review process in real-time. Read more

Reminder: Provider signatures on patient notes are essential for claims processing

By AMELIA MARCH, Manager-Special Investigations Unit

Following a visit with a patient in any discipline, a signature is the crucial last piece in completing a visit note. Whether it be an electronic medical record or handwritten one, this final step has a large impact on claims processing when medical records are needed for review. Without a signature, it can result in a denied claim due to lack of authenticity and/or legitimacy of the record. Read more

Reminder: Proper coding is required when billing for flu vaccinations

By JENNIFER DENNEE, Supervisor-Claims, Government

Security Health Plan follows the Centers for Medicare and Medicaid Services guidelines for vaccinations. As flu season will be upon us shortly, please remember to review the coding guidelines to ensure the appropriate administration is being billed for each vaccine submitted. This also applies to other Medicare Part B covered vaccines such as the Pneumococcal and Hepatitis B vaccines for high-risk individuals. Read more

Policy review

Security Health Plan September 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

New changes ahead for some of Security Health Plan’s skin procedures medical policies  

Effective Oct.1, the Skin Substitute, Chemical Peels, Dermabrasions, and other Skin Procedures Medical Policy has several changes. First, the prior authorization will be removed from the policy effective Oct. 1. Read more

Pharmacy updates

Magellan Rx Management to become “Prime Therapeutics Management”

By AMANDA SIEGLER, PharmD, Clinical Pharmacy Specialist

Effective Oct. 1, Magellan Rx Management, Security Health Plan’s vendor partner that provides medical pharmacy solutions, will be renamed “Prime Therapeutics Management.” In December of 2022, Magellan Rx Management, LLC (MRx) was acquired by Prime Therapeutics LLC (Prime). Read more

Security Health Plan updates

Security Health Plan continues efforts to ensure members receive language assistance services

By CHARLIE JONES, Quality Program Coordinator

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

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

ProAuth updates make it easier for provider to view TruCare letters

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

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.