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.
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.
- durable medical equipment
- prosthetic-orthotic services
- amino acid formula
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. In addition, home infusion services may also require prior authorization.
Home infusion drugs
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
Fax an eviCore request form (available online) to 1-888-693-3210
For radiation oncology
For cardiac imaging, heart catheterization and sleep management services
Services that require prior authorization
Applying your coverage
When you or your provider ask Security Health Plan to cover certain medical or behavioral health services or prescription drugs, we carefully and thoroughly review the request to ensure your coverage is applied correctly based on the terms of your plan.
- Decision-making is based only on appropriateness of care and service and existence of coverage.
- Security Health Plan does not specifically reward providers or any other individuals for issuing denials of coverage.
- Security Health Plan does not have financial incentives in place for decision makers; therefore, decision makers are not encouraged to make decisions that result in underutilization.