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Prior authorization

Prior authorization by Security Health Plan is required before receiving certain services to ensure coverage and payment for those services. Please have your doctor complete a prior authorization form and submit it to Security Health Plan if you plan to receive any of these services.

When is prior authorization needed?

Security Health Plan requires prior authorization for some medical services or equipment. While a provider will generally make these requests and submit the necessary forms, it is a member’s responsibility to make sure the process is followed. A health care provider may contact Security Health Plan to determine whether a prior authorization is required for a member’s service or medical equipment by calling our Provider Assistance Line at 1-800-548-1224. Click here to view a list of services that require prior authorization.

Please note: The Security Health Plan prior authorization requirements apply regardless of whether or not we are your primary or secondary coverage. If the claim will eventually be billed to Security Health Plan (whether we are your primary or secondary insurer), prior authorization will be required for payment.

Prior authorization requirements apply to all plans from Security Health Plan.

Prior authorization requirements apply to services requested directly from Security Health Plan and to those requested from vendors contracted by Security Health Plan, such as, but not limited to, eviCore, NaviHealth, Magellan or Northwood for Security Health Plan members. 

Prior authorization should be sought for workers’ compensation/liability cases to avoid denials in the event workers’ compensation/liability coverage is denied or exhausted.

If you are being seen for an injury believed to be work-related and covered by workers’ compensation, the services should be prior authorized at the same time the service is provided. This is to ensure coverage in the event the workers’ compensation claim is denied.


Prior authorizations from Northwood, Inc.

All services for durable medical equipment,  prosthetic-orthotic services and amino acid formula will require prior authorization from Northwood, Inc.

Security Health Plan has partnered with Northwood, Inc., to manage the following services. Your provider will work with Northwood to ensure that authorizations are in place for products and services you receive.


Pharmacy prior authorizations

Some prescription drugs that you receive from a pharmacy may require prior authorization. To see what drugs require authorization click the  "Find prescriptions" button below.
Find prescriptions

Medical benefit drugs

Medical benefit drugs (covered by Part B for members with Medicare) are injected or infused while you are in a provider's office, a hospital outpatient or ambulatory surgical center and may require prior authorization. For more information, click the "Learn more" button  below.

Learn more

Home infusion drugs

Some medical benefit drugs are eligible for coverage by home infusion.    Home infusion services may require prior authorization. To learn more click the  "See what's covered" button below.
See what's covered

Skilled nursing services that require prior authorization

acute rehabilitation admission
long-term acute care admission
skilled nursing facility admission

Services that require prior authorization from eviCore

For all high-end imaging, radiation oncology services, cardiac imaging, heart catheterization and sleep management services you will need to work with your provider to receive prior authorization from eviCore healthcare.

For high-end imaging

www.evicore.com
Phone 1-888-693-3211
Fax an eviCore request form (available online) to 1-888-693-3210

For radiation oncology

www.carecorenational.com
Phone 1-888-444-6185

For cardiac imaging, heart catheterization and sleep management services

www.evicore.com
Phone   1-888-444-6185

Services that require prior authorization