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Information from your health plan about COVID-19 (coronavirus disease)

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New information for Security Health Plan providers

News and  announcements that will help you work more efficiently with  Security Health Plan coverage. We've also included  current and past issues of our Provider News newsletters for easy reference.

Risk Adjustment

Risk Adjustment and Hierarchical Condition Category (HCC) coding is a payment model mandated by the Centers for Medicare and Medicaid Services (CMS) in 1997

Coronavirus Disease 2019 (COVID-19): Coverage information and resources

CMS and Wisconsin ForwardHealth have provided waivers and updates that allow medical providers to focus on treating patients with COVID-19 more efficiently. In line with these waivers and updates, Security Health Plan’s COVID-19 Provider FAQ details our revised processes related to prior authorizations/utilization management, testing/treatment coverage and billing, telehealth coverage and billing, general billing questions and provider practice changes. The Provider FAQ will be updated continuously as new information is received from CMS and Wisconsin DHS.

A link to the Provider FAQ can be found on our COVID-19 webpage, which includes information that may affect our key stakeholders, including our members, brokers, employers and providers.

Security Health Plan to manage musculoskeletal and therapy prior authorizations for members in Security Administrative Services plans

Effective Jan. 1, 2020, Security Health Plan will manage musculoskeletal procedure and outpatient therapy prior authorizations (PA) for members enrolled in  certain  Security Administrative Services (SAS) plans, regardless of the rendering provider. Click here    to learn more including the SAS plans and specific procedures and treatments that require PA from Security Health Plan. 

 

 

CMS Offers New Resources to Help Clinics Improve Physical Access for People with Disabilities

In recognition of the Americans with Disabilities Act, the Centers for Medicare and Medicaid Services Office of Minority Health (CMS OMH) offers several new resources to help improve physical accessibility for people with disabilities. The CMS memo describes resources available for providers as well as patients.   Click here   to view the memo and access links to important resources to help you make your practice more accessible.

Payment methodology changes for home health under new CMS PDGM model

Effective Jan. 1, 2020, the Centers for Medicare and Medicaid Services (CMS) will be implementing a new Home Health Patient-Driven Groupings Model (PDGM). The PDGM is a new payment model for the Home Health Prospective Payment System (HH PPS).

The PDGM relies more heavily on clinical characteristics and other patient information to place home health periods of care into meaningful payment categories and eliminates the use of therapy service thresholds. In conjunction with the implementation of the PDGM, there will be a change in the unit of home health payment from a 60-day episode to a 30-day period. Learn more.

New Skilled Nursing  Payment Model

Effective October 1, 2019, Centers of Medicare and Medicaid (CMS) implemented a new Skilled Nursing Patient-Driven Payment Model (PDPM).  Security Health Plan has implemented the new payment model to its skilled nursing facility Medicare Advantage contracts to stay compliant with Medicare Advantage contractual language and CMS reimbursement requirements. Learn more.

Provider Forum Invitation

eviCore is  leading Provider Forums designed to review provider resources available for Security Health Plan prior authorizations.  The Provider Forums will review how to access resources available on www.eviCore.com and https://www.evicore.com/resources/healthplan/security-health to assist with the prior authorization process. All forums require advance registration.    Learn more about the forum.   

ProAuth prior authorization submission process 

Security Health Plan has a new application for prior authorization submissions. Click here  to view frequently asked questions about this new program, ProAuth.

Provider Portal Enhancement

Security Health Plan is in the process of upgrading its Population Health Platform which went live on Sept. 19, 2019.  Part of this process is an addition of the TruCare ProAuth feature. This is a web portal application that allows providers to submit inpatient and service/procedure authorization requests.  These requests will include both medical and behavioral health conditions. The authorization request can be submitted and have clinical review validation with IQ Connect.

The functional capabilities will allow the providers to go through a prescreen process.  This process informs the providers whether a Security Health Plan member is eligible, if authorization is required, duplicate requests, auto approvals of authorization, and extension to the initial request services. These processes are all driven through the business rule of the TruCare ProAuth tool.

The provider has limited impact to this enhancement as current provider portal users will access this tool through the current Security Health Plan provider portal. When the provider attempts to create a Medical/Behavioral authorization, the provider is transitioned to the TruCare ProAuth tool.  The same requirement is needed to complete an authorization request: member name, member date birth, ICD-10, CPT/HCPCS codes, dates of service, ordering and service providers’ information, relevant clinical information with the ability to attach documents within this request.  If the authorization meets the business rule set up by the provider, they could receive that approval at the time of the request.

Click the links below to watch a demo of Security Health Plan’s ProAuth system which can be used to submit authorization electronically.

To view step-by-step instructions for ProAuth, click here.  This reference guide walks you through the  process to submit an electronic prior authorization request.

If you currently do not have portal access, contact your organization administrator.   If your organization does not currently use the Provider Portal but would like to get access, please download the "Security Health Plan Provider Portal Access Request Form."

Security Health Plan partners with eviCore healthcare for prior authorization services

Effective July 1, 2019, eviCore healthcare is providing prior authorization services for patients enrolled with Security Health Plan. Prior authorization will be required for  cardiac imaging, elective heart catheterization    and sleep management services  for dates of service beginning July 1, 2019. 

Security Administrative Services (SAS) is moving all claims to the Security Health Plan claims processing platform

Effective June 1, 2019, Security Administrative Services (SAS) is moving all claims to the Security Health Plan claims processing platform. Also effective June 1, 2019, provider access to the old SAS Portal will be terminated and providers should begin accessing all SAS information from the Security Health Plan Provider Portal at the following link for the functions noted below https://provider.securityhealth.org/Account/Login?ReturnUrl=/

Please email sascs@sastpa.com or call 800-570-8760 with any questions.

Security Health Plan transitions acute rehabilitation and long term care prior authorization (PA) services

Effective March 1, 2019, PA services for Security Health Plan members  is required for   acute rehabilitation  and long-term care  admissions.

Security Health Plan partners with eviCore healthcare for prior authorization (PA) services

Effective May 1, 2019, eviCore healthcare is providing PA services for patients enrolled with Security Health Plan. Prior authorization will be required for joint surgery, spine (hip, knee and shoulder) surgery, interventional pain management, occupational therapy, physical therapy and speech therapy. Learn more.

eviCore to handle authorization for musculoskeletal (joint/spine surgery/pain interventions) and therapy services (physical therapy, occupational therapy and speech therapy)

eviCore healthcare has been contracted by Security Health Plan to provide prior authorization review of certain musculoskeletal and therapy services for dates of service (DOS)   May 1, 2019 and forward. Click below for details and information on provider orientation sessions.

eviCore  Musculoskeletal & Therapy announcement letter
eviCore  Musculoskeletal provider orientation invitation
eviCore Therapy  provider orientation invitation

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Contact Information


Security Health Plan Provider Relations and
Contracting Department
shpprd@securityhealth.org
715-221-9640 or
1-800-548-1224