Security Health Plan has programs available that are above and beyond the normal benefit to help improve member health. Security Health Plan identifies members, using established criteria and assessment tools, who may benefit from these programs. Not all members are eligible for these programs. If a member is selected to participate, they must also be willing to participate in Security Health Plan’s Case Management program. These programs are available at no extra charge to the member.
Referring members: As a provider, you are encouraged to refer members who you think would benefit from any of the programs listed below to Security Health Plan. Referrals, which are at Plan’s discretion, may result from, but are not limited to members receiving hospital inpatient, skilled nursing facility or chronic care services or health assessment results. Please call our provider assistance line (PAL) at 1-800-548-1224 and ask to speak to a care manager.
Below is a brief summary of the programs available to members (with the exception of members enrolled in Family Health Center, MSA or Medicare Supplement plan).
1. Nurse On-Call programRequired criteria: Not homebound; in need of one home visit to assess for home maintenance management, safety, psychosocial/behavioral health needs; and member must give verbal consent to Security Health Plan Care Manager. Reimbursable code: 99600
2. Telemonitor program
Criteria: Not homebound; Class III or IV CHF; frequent hospital admissions or ER visits; in need of disease self-management stabilization; member consents to Security Health Plan Case Management enrollment and is agreeable to placement of the monitor in their home. Reimbursable code(s): S9110-21 and 99600
Prenatal Care Coordination Services (PNCC)
Prenatal care coordination services help a recipient and the recipient’s family gain access to medical, social, educational and other services related to pregnancy. Wisconsin Medicaid PNCC services are available to Medicaid-eligible pregnant women with a high risk for adverse pregnancy outcomes during pregnancy through the first 60 days following delivery.
- Initial assessment
- Care plan development
- Ongoing care coordination and monitoring
- Health education and nutrition counseling services (for recipients with an identified need)
The goal of PNCC is to improve birth outcomes among women who are deemed at high risk for poor birth outcomes. The main objectives to achieve this goal include ensuring that women at high risk:
- Are identified as early as possible in their pregnancy.
- Receive individual psychosocial support and services.
- Receive early and continuous prenatal care services.
- Receive necessary health and nutrition education.
- Are referred to available community services, as appropriate.
- Receive assistance in accessing and obtaining needed health and social services.
- Verify a recipient’s Medicaid eligibility
- Pregnant women with a high risk for adverse pregnancy outcomes