Accreditation reflects excellence
How we assure quality of our services
Quality management and improvement
We make sure the health services you receive are effective and timely. We work with our providers to identify opportunities to improve care and service.
Credentialing and provider relations
Using NCQA specifications, we thoroughly screen healthcare providers when they apply to be part of our network. Then we periodically check to make sure they maintain their professional credentials and quality. Our representatives visit clinics to assure that providers are consistently providing the highest possible quality of care.
Utilization management
We want to do what’s best for our members. We help you control costs by requiring prior authorization in certain situations and checking to make sure you receive care in the most efficient location for your condition. We help coordinate home healthcare services with your doctor to get you out of the hospital, and back into your home, sooner. We also measure how well services such as preventive care are used.
Non-compensation statement
Security Health Plan does not use incentives to encourage barriers to care and service.
1. Utilization management (UM) decision-making is based only on appropriateness of care and service and existence of coverage.
2. Security Health Plan does not specifically reward providers or any other individuals for issuing denials of coverage.
3. Security Health Plan does not have financial incentives in place for UM decision makers.
4. UM decision makers are not encouraged to make decisions that result in underutilization.
Preventive health services
We encourage all of our members to get the services they need to stay healthy. Our plans include coverage for immunizations, mammograms, cervical cancer screenings, colonoscopies and many other preventive health services.
Clinical practice guidelines
Security Health Plan regularly reviews medical literature and opinions. We publish clinical practice guidelines for our providers' and to keep you updated on health information. View the guidelines.
We stay on top of medical advances
We evaluate new technology in medical care and treatment on a regular basis to determine when new services should be covered. Security Health Plan medical experts review information from government health agencies and scientific publications. We also get input from providers who offer the service.
Member rights and responsibilities
Medical record standards
We follow strict standards that ensure:
- Our members’ medical records are maintained properly
- Physicians follow up quickly on test results
- Specialists and primary care providers communicate effectively
Independent studies show that Security Health Plan members generally:
- Have fewer unnecessary hospitalizations
- Pay fewer unnecessary healthcare costs
- Find it easier to get tests and treatments they need
- Have fewer hassles with claims
- Are more satisfied with their health plan**
Producing results every day
Security Health Plan uses resources such as the Healthcare Effectiveness Data and Information Set (HEDIS) to improve healthcare outcomes for our members.Effectiveness of care
We evaluate childhood and adolescent immunization rates, flu shots for older adults, post-natal check-ups, cancer screening rates and the overall health of all our members.
Care access
Security Health Plan ensures the availability of primary care, mental health/chemical dependency, obstetrical and prenatal providers. We work closely with pregnant members to encourage early prenatal care.
Informed healthcare choices
Our members need the right information to make wise healthcare choices. At Security Health Plan we provide new member education. To meet the needs of our diverse population, we also provide language translation services.