Prior Authorization (PA) / Notification requirements
Changes to an approved prior authorization – notification prior to planned services
When a provider has a change to services that have already been prior authorized by Security Health Plan, the provider must notify Security of the change(s) to the PA on file a minimum of 10 days prior to the services being provided. Notify Security Health Plan of changes by fax at 1-715-221-6616 or by phone at 1-800-991-8109 (option #1 or #2) or 715-221-9661. Examples of changes for which the provider must notify Security include the items listed below. This list is not all-inclusive. If the provider does not notify Security Health Plan of the changes prior to the procedure, the claims for the unauthorized codes will be denied.
- level of care
- procedural/coding changes
- site of service
- date of service
- provider providing service
Changes to an approved prior authorization which occur intraoperatively during a planned procedure
If a provider changes any of the prior authorized service(s) during surgery to perform services other than the ones for which PA was obtained, provider must contact Security Health Plan within 72 business hours of the procedure to provide the new CPT code(s) that were performed. Provider must notify Security Health Plan via fax at 1-715-221-6616 or by phone at 1-800-991-8109 (option #1 or #2) or 715-221-9661 with the updated information. If provider does not notify Security Health Plan of the changes within 72 business hours of procedure, the claims for the unauthorized codes will be denied.
List of services that require prior authorization
Please select from the drop-down menu for services that require prior authorization or notification. NOTE: Medicare Advantage HMO-POS does not include Secure Saver MSA.
Abdominoplasty
Abdominoplasty is a surgical procedure that tightens a lax abdominal wall and removes excess abdominal skin. It may be reconstructive or cosmetic.
Security Health Plan requires prior authorization for this service. Please complete the form below.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Acute Rehabilitation Admission
Prior authorization must be obtained from naviHealth for acute rehabilitation admissions.
Security Health Plan requires pre-certification from naviHealth for this service.
• Call: 1-855-512-7002
• Fax: 1-855-847-7243
Click here for more details on pre-certification notification and concurrent review
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Air Ambulance Transport
Security Health Plan provides coverage for air/helicopter transportation in a critical emergency situation when ground ambulance is not medically safe or appropriate due to time constraints.
Security Health Plan requires prior authorization for this service.
- Call for information: 1-800-991-8109
- Fax: 1-715-221-6616
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Amino Acid
Security Health Plan requires prior authorization for these services.
Please contact Northwood if your plan has coverage/guidelines for amino based acids.
- Online: www.northwoodinc.com/security-health-plan/
- Call: 1-888-532-1344
- Fax: 1-866-483-9988
- Provider Portal for entities contracted with Northwood, Inc.: https://providerportal.northwoodinc.com
You may need to search for contracts under Security Health Plan and Security Administrative Services on the Northwood, Inc. Provider Portal to identify member eligibility for groups that have or are currently transitioning to Security Administrative Services.
Product line(s):
BadgerCare, Commercial, Family Health Center, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Medicare Medical Savings Account (MSA), Security Administrative Services
Autologous Cultured Chondrocytes
Autologous cultured chondrocytes are a type of cartilage tissue graft. Indications for use are for the repair of cartilage defects of the knee, including meniscal knee injuries, chondromalacia, and other disorders of cartilage of the knee.
Security Health Plan requires prior authorization through eviCore for this service for BadgerCare, Commercial, and Medicare Advantage HMO-POS.
- Online: log into www.evicore.com
- Call: 1-888-444-6185
- Fax: 1-800-540-2406
Security Health Plan requires prior authorization through Security Health Plan for this service for Marshfield Clinic Health System and Security Administrative Services. Complete the form below.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Breast Reconstruction Post Mastectomy
If this request is for the treatment of breast cancer, no prior authorization is required due to the Women’s Health and Cancer Rights Act of 1998, both reconstruction and implants are covered. This covers both affected and non-affected breast.
Security Health Plan requires prior authorization for this service. Please complete the form below.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Cardiac imaging and elective heart catheterization
eviCore handles prior authorization of all cardiac imaging and elective heart catheterization procedures including Cardiac Advanced Imaging: CT, MR, PET, Nuclear Cardiology (includes nuclear stress testing), Echo Stress Testing, Echocardiography, Diagnostic Heart Catheterization.
Security Health Plan requires prior authorization through eviCore for all the above listed services for BadgerCare, Commercial and Medicare Advantage HMO-POS.
Security Health Plan requires prior authorization through eviCore for Cardiac Advanced Imaging: CT, MR, PET, Nuclear Cardiology (includes nuclear stress testing) for Security Administrative Services.
Security Health Plan requires prior authorization from eviCore for this service.
- Online: log into www.evicore.com
- Call: 1-888-693-3211
- Fax: 1-888-693-3210
Click here for more details.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Carpal Tunnel Surgery
Carpal tunnel syndrome is a condition of the wrist that results in pain and numbness. It is caused by a pinched nerve in the wrist.
Security Health Plan requires prior authorization and certain criteria must be met to receive approval for this service.
Security Health Plan requires prior authorization for this service.
- Call for information: 1-800-991-8109
- Fax: 1-715-221-6616
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Chemotherapy Infusion
Magellan RX Management reviews select medications for the outpatient and home infusion setting. For a list of which therapies require PA (prior authorization) or PSCE (post service claim edit) please click here.
Security Health Plan reviews requests for elective inpatient chemotherapy administration. Please click the form below to submit a pre-certification request. In order to be approved, the regimen must be prescribed by an oncologist/hematologist and the regimen must be FDA-approved or supported by approved compendia.
For medications managed by Magellan please contact Magellan customer service or visit their website:
- Call: 1-800-424-8243
- Online: ih.magellanrx.com
Security Health Plan requires pre-certification for elective inpatient chemotherapy administration.
- Call for information:1-800-991-8109
- Fax: 1-715-221-6616
Product line(s):
Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Clinical Trials
A “clinical trial” is a type of research study that tests how well new medical treatments or other interventions work. Clinical trials are one of the final stages of a research process designed to test new methods of screening, and to find better ways to prevent, diagnose, or treat diseases.
Security Health Plan requires prior authorization for this service.
- Call for information: 1-800-991-8109
- Fax: 1-715-221-6616
Product line(s):
Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Cosmetic Reconstructive Surgery
Cosmetic services are defined as services and procedures to improve the patient’s self-esteem, personal well-being, or to indirectly treat psychiatric or emotional problems or disorders, as well as procedures done solely to improve appearance. This would also include services and procedures provided in connection with or resulting from complications of cosmetic services or procedures.
Security Health Plan requires prior authorization for this service.
- Call for information: 1-800-991-8109
- Fax: 1-715-221-6616
Product line(s):
BadgerCare, Commercial, Family Health Center, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Durable Medical Equipment - Prosthetic - Orthotic Suppliers
A provider must submit the prior authorization for durable medical equipment (DME) to Northwood, Inc. Durable medical equipment (DME) is equipment needed for medical reasons, which is sturdy enough to be used many times without wearing out. A person normally needs this kind of equipment only when ill or injured. It can be used in the home. Examples include wheelchairs, crutches, IV infusion pump, nebulizer, walker, hospital beds, or equipment that supplies a person with oxygen.
Security Health Plan requires prior authorization for these services through Northwood.
- Online: www.northwoodinc.com/security-health-plan/
- Call: 1-866-532-1344
- Fax: 1-866-483-9988
- Provider Portal for entities contracted with Northwood, Inc.: https://providerportal.northwoodinc.com
You may need to search for contracts under Security Health Plan and Security Administrative Services on the Northwood Inc. Provider Portal to identify member eligibility for groups that have or are currently transitioning to Security Administrative Services.
Product line(s):
BadgerCare, Commercial, Family Health Center, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Medicare Medical Savings Account (MSA), Security Administrative Services
Elective Inpatient Admission
Pre-certification is the process of reviewing an inpatient admission prior to the proposed admission date. In general, affiliated hospitals or the admitting provider contacts Security Health Plan to pre-certify elective inpatient admissions/procedures.
This prior authorization includes medical, surgical and behavioral health procedures.
Security Health Plan requires pre-certification for this service.
- Call for information: 1-800-991-8109
- Fax: 1-715-221-6616
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Electroconvulsive Therapy
Electroconvulsive therapy (ECT), also known as electroshock therapy, involves the intentional induction of generalized seizures by administering electrical impulses to the anesthetized patient.
Security Health Plan requires prior authorization for this service. Please complete the form below.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Enteral Feedings
Enteral nutrition generally refers to any method of feeding that uses the gastrointestinal (GI) tract to deliver part or all of a person's caloric requirements. It can include a normal oral diet, the use of liquid supplements or delivery of part or all of the daily requirements by use of a tube (tube feeding).
Security Health Plan requires prior authorization through Northwood for these services.
- Online: log into http://www.northwoodinc.com/security-health-plan/
- Call: 1-888-532-1344
- Fax: 1-866-483-9988
- Provider Portal for entities contracted with Northwood, Inc.: https://providerportal.northwoodinc.com
Product line(s):
BadgerCare, Commercial, Family Health Center, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Experimental or Investigational Services
The use of any service including treatment, procedure, facility, equipment, drug, object, device, or supply that:
- requires approval that has not been granted by the appropriate federal or other governmental agency at the time it is used,
- is not yet recognized as acceptable medical practice to treat that illness or injury, or
- is the subject of an ongoing clinical trial that meets the definition of a Phase I, II or III clinical trial set forth in FDA regulations, regardless of whether the trial itself is subject to FDA oversight.
Security Health Plan requires prior authorization for this service.
- Call for information: 1-800-991-8109
- Fax: 1-715-221-6616
Product line(s):
BadgerCare, Commercial, Family Health Center, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Eyelid and Brow Repair Procedures
Security Health Plan requires prior authorization for these services. Please complete the form below.
Product line(s):
BadgerCare, Commercial, Family Health Center, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Femoroacetabular Impingement Surgery
Femoracetabular Impingement Surgery is a surgical procedure to improve range of movement and reduce pain.
Security Health Plan requires prior authorization through eviCore for this service for BadgerCare, Commercial, and Medicare Advantage HMO-POS.
- Online: log into www.evicore.com
- Call: 1-888-444-6185
- Fax: 1-800-540-2406
Security Health Plan requires prior authorization through Security Health Plan for this service for Marshfield Clinic Health System and Security Administrative Services. Complete the form below.
Product line(s):
Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Genetic, Genomic and Molecular Testing
Genetic/Genomic/Molecular testing identifies changes in chromosomes or genes which can confirm or rule out a suspected chromosomal or genetic condition, and/or which can help determine patient management, the risk of fetal genetic or chromosomal conditions, and/or the chance of developing or passing on a condition.
Genetic/genomic/molecular analysis of tumor, bone marrow, or blood samples in patients with or suspected of having malignancy or myelodysplastic, myeloproliferative, or pre-cancerous conditions may provide information to inform prognosis, and/or guide targeted therapy and/or cancer surveillance.
Security Health Plan requires prior authorization for this service. Please complete the form below.
Product line(s):
BadgerCare, Commercial, Family Health Center, Marshfield Clinic Health System, Security Administrative Services
High end imaging services (CT scan, Low dose CT for Lung cancer screening, MRI and PET)
eviCore handles prior authorization of all high-end imaging (HEI) services. HEI include CT, Low dose CT for Lung Cancer Screening, MRI and PET.
Security Health Plan requires prior authorization from eviCore for this service.
- Online: log into https://www.evicore.com/
- Call: 1-888-693-3211
- Fax: 1-888-693-3210
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Home Health
Home health includes healthcare services provided directly to a member in the member’s home. A written home care plan submitted by the member’s attending physician and approved by Security Health Plan is required.
This prior authorization includes skilled nursing, physical therapy, occupational therapy and speech therapy services.
Security Health Plan requires prior authorization for this service. Please complete the form below.
Specific to Medicare products: Security Health Plan has implemented the new CMS Home Health Patient-Driven Groupings Model (PDGM). 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. Prior authorization requirements remain the same at every 60 days.
Product line(s):
BadgerCare, Commercial, Family Health Center, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Home Infusion - Other IV Infusion
For home infusion services that require prior authorization, click here for more details.
For medications managed by Magellan please contact Magellan customer service or visit their website:
- Online: ih.magellanrx.com
- Call: 1-800-424-8243
Product line(s):
BadgerCare, Commercial, Family Health Center, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Hospital Admission - Pre-certification
Pre-certification is the process of reviewing an inpatient admission prior to the proposed admission date. In general, affiliated hospitals or the admitting provider contacts Security Health Plan to pre-certify elective inpatient admissions/procedures.
Security Health Plan requires pre-certification for this service.
- Call for information: 1-800-991-8109
- Fax: 1-715-221-6616
Click here for more details.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Hospital Observation Admission
Security Health Plan requires the facility to send notification, along with clinical, when the member’s observation stay reaches 48 hours. This needs to be submitted prior to the member’s 48th hour.
Security Health Plan requires prior notification for this service.
- Call for information: 1-800-991-8109
- Fax: 1-715-221-6616
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Hyaluronic Acid
Derivatives are FDA approved for osteoarthritis of the knee. These agents are injected into the knee joints to increase the elastoviscous properties of arthritic joint fluid and also help to slow the outflow of joint fluid from the joint. The hyaluronic acid derivatives help to restore viscoelasticity, decrease pain, and improve mobility.
No prior authorization is required for Gel-One and Hyalgan. Gel-One will be managed on the post service edits through Magellan Rx. Patients must have tried and have had an inadequate response, contraindication, or intolerance to all of the preferred products prior to using a non-preferred product.
Click here for more details about the hyaluronic acids
Product line(s):
Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Infuse Bone Graft
Patients with degenerative disc disease of the lumbar or cervical spine who have failed to respond to conservative therapy can be treated with a surgical procedure, referred to as spinal fusion or arthrodesis. Bone grafts are commonly used in this procedure to promote fusion of adjacent vertebrae.
Security Health Plan requires prior authorization through eviCore for this service for BadgerCare, Commercial, and Medicare Advantage HMO-POS.
- Online: log into www.evicore.com
- Call: 1-888-444-6185
- Fax: 1-800-540-2406
Security Health Plan requires prior authorization through Security Health Plan for this service for Marshfield Clinic Health System and Security Administrative Services. Complete the form below.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Intravenous Iron Therapy
Iron infusion is a procedure in which iron is delivered to your body intravenously. No prior authorization is required if the iron infusion is for one of the following medications: iron sucrose (Venofer®), ferric gluconate (Ferrlecit®) and iron dextran (Infed®).
If you use any other iron infusion, Security Health Plan requires prior authorization for this service. Please complete the form below.
Product line(s):
Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Knee Arthroscopy
Arthroscopy is a minimally invasive procedure that allows direct visualization of the interior of a joint. Knee arthroscopy allows orthopedic surgeons to assess, and in some cases treat, a range of conditions affecting the knee joint.
Security Health Plan requires prior authorization through eviCore for this service for BadgerCare, Commercial, and Medicare Advantage HMO-POS.
- Online: log into www.evicore.com
- Call: 1-888-444-6185
- Fax: 1-888-785-2485
Security Health Plan requires prior authorization through Security Health Plan for this service for Marshfield Clinic Health System and Security Administrative Services. Complete the form below.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Lipectomy
Lipectomy is the excision of fatty tissue.
Security Health Plan requires prior authorization for this service. Please complete the form below.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Long Term Acute Care Admission
LTAC (Long-term acute care) admissions are reviewed by Security Health Plan prior to admission to the facility.
Security Health Plan requires pre-certification for this service.
- Call for information: 1-800-991-8109
- Fax: 1-715-221-6616
Click here for more details on long term acute care.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Medicare Advantage Coverage Inquiry
Per the Medicare ruling, members are allowed an organization determination for services that may not be covered by the plan. The organization determination is a request made by the provider via the ‘Medicare Advantage Coverage Determination Request’ form to the Health Plan to verify if a service would be covered or not.
Security Health Plan requires prior authorization for this service. Please complete the form below.
Product line(s):
Medicare Advantage HMO-POS, Medicare Medical Savings Account (MSA)
Musculoskeletal and Therapies Program
eviCore handles prior authorization of the following musculoskeletal and therapy services: Joint Surgery, Spine Surgery, Interventional Pain Management, Occupational Therapy, Physical Therapy, Speech Therapy.
Click here for more details on the Musculoskeletal and Therapies Program.
Security Health Plan requires prior authorization through eviCore for these services for BadgerCare, Commercial, and Medicare Advantage HMO-POS.
- Online: log into www.evicore.com
Musculoskeletal/Pain Management
- Call: 1-888-444-6185
- Fax: 1-800-540-2406
Therapies
- Call: 1-888-444-6185
- Fax: 1-888-774-1319
Security Health Plan requires prior authorization through Security Health Plan for musculoskeletal and therapy services: Joint Surgery, Spine Surgery, Occupational Therapy, Physical Therapy, Speech Therapy for Security Administrative Services.
See the following prior authorization forms:
- Autologous Cultured Chondrocytes
- Core Decompression
- Femoroacetabular Impingement Surgery
-
Infuse Bone Graft
-
Knee Arthroscopy
-
Total Hip Replacement
-
Total Knee Replacement
Back surgery – including Lumbar surgery, Cervical/Thoracic surgery and Vertebroplasty.
Please call 1-800-991-8109 or fax all relevant information to 715-221-6616
.
Therapies:
- Initial Therapy - See Outpatient Therapy Treatment Initial
- Concurrent therapy - See Outpatient Therapy Treatment Concurrent
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Non-affiliated Providers Request
Security Health Plan requires prior authorization for services received by non-affiliated providers. Please complete the form below.
Click here for more details.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Non-emergent Ambulance Transport
Prior authorization is required for medical necessity of the non-urgent ambulance transport.
Security Health Plan requires prior authorization for this service.
- Call for information: 1-800-991-8109
- Fax: 1-715-221-6616
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Oral Appliance
An oral mandibular appliance is a device that is inserted into the mouth in order to modify the position of the mandible, tongue, and other structures in the upper airway for the purpose of relieving snoring or sleep apnea.
Security Health Plan recommends prior authorization for this service for all plans. Please complete the form below.
Product line(s):
Commercial, Family Health Center, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Outpatient Therapy Treatment Concurrent
A request for concurrent therapy treatment is required for any additional services needed after the initial services have been approved.
Click here for more details on the Musculoskeletal and Therapies Program.
Security Health Plan requires prior authorization through eviCore for this service for BadgerCare, Commercial, Medicare Advantage HMO-POS.
- Online: log into www.evicore.com
- Call: 1-888-444-6185
- Fax: 1-888-785-2485
Security Health Plan requires prior authorization through Security Health Plan for this service for Marshfield Clinic Health System and Security Administrative Services. Complete the form below.
Product line(s):
Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Outpatient Therapy Treatment Initial
Once the initial evaluation is completed, an "Initial Therapy Request" form for outpatient physical therapy must be requested prior to receiving additional therapy services.
Click here for more details on the Musculoskeletal and Therapies Program.
Security Health Plan requires prior authorization through eviCore for this service for BadgerCare, Commercial, and Medicare Advantage HMO-POS.
- Online: log into www.evicore.com
- Call: 1-888-444-6185
- Fax: 1-888-774-1319
Security Health Plan requires prior authorization through Security Health Plan for this service for Marshfield Clinic Health System and Security Administrative Services. Complete the form below.
Product line(s):
Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Panniculectomy
Panniculectomy is a surgical procedure that removes excess skin, subcutaneous tissue, and adipose tissue from the abdomen. It is often performed after a patient has experienced childbirth or a large amount of weight loss resulting in redundant abdominal tissue.
Security Health Plan requires prior authorization for this service. Please complete the form below.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Pharmaceuticals - Specialty Medications by Magellan or Security Health Plan
For medications managed by Magellan please contact Magellan customer service or visit their website:
Call: 800-424-8243
Online: ih.magellanrx.com
For specialty medications reviewed by Security Health Plan call 1-800-991-8109.
Click here for more details.
Product line(s):
Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Pharmaceuticals - Unclassified Medical Benefit Drug
Security Health Plan manages select medications which have unclassified J-Codes.
Click here for more details.
Product line(s):
Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services, BadgerCare, Family Health Center
Port Wine Stain - Abnormal Vascular Lesion Treatment
Port-wine stain is a red to blue colored discoloration of the skin present at birth that mostly occurs on the face, but may also be present elsewhere. It generally does not enlarge out of proportion or resolve over time.
Security Health Plan requires prior authorization for this service. Please complete the form below.
Product line(s):
BadgerCare, Commercial, Family Health Center, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Radiation Oncology Services
Radiation oncology requires prior authorization. Contact eviCore at 1-888-665-8341.
Security Health Plan requires prior authorization through eviCore for this service.
- Online: log into www.carecorenational.com
- Call: 1-888-444-6185
- Fax:1-888-693-3210
Click here for more details.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Radicava
Magellan RX Management reviews select medications for the outpatient and home infusion setting. For a list of which therapies require PA (prior authorization) or PSCE (post service claim edit) please click here.
For medications managed by Magellan please contact Magellan customer service or visit their website:
- Online: ih.magellanrx.com
- Call: 1-800-424-8243
Product line(s):
Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Reduction Mammoplasty
Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the breasts by removing excess fat, glandular tissue, and skin. The goals of the surgery are to relieve symptoms caused by heavy breasts, to create a natural, balanced appearance with normal location of the nipple and areola, to maintain the capacity for lactation, and allow for future breast exams and mammograms with minimal scarring or decreased sensation.
Security Health Plan requires prior authorization for this service. Please complete the form below.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Rhinoplasty
Rhinoplasty is surgical reshaping of the nose, generally for cosmetic reasons, unless there has been a recent traumatic injury to the nose that results in nasal airway obstruction.
Security Health Plan requires prior authorization for this service. Please complete the form below.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Second Opinion
Security Health Plan allows members to receive a second opinion from an in-network provider (without a referral) or an out-of-network provider (with an approved prior authorization).
Security Health Plan requires prior authorization for this service.
- Call for information: 1-800-991-8109
- Fax: 1-715-221-6616
Surgical second opinion prior authorization maybe required for Security Administrative Services.
Click here for more details.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Security Administrative Services
Septoplasty
Septoplasty is the surgical repair of the nasal septum, which is the tissue, bone and cartilage that separates the nostrils, so that it is straight and centered. Septoplasty can improve nasal breathing and reduce nasal obstruction.
Security Health Plan requires prior authorization for this service. Please complete the form below.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Site of Service Inpatient Based Procedure
Prior authorization is required for inpatient procedures being requested to be performed in an ASC.
Security Health Plan requires pre-certification for this service.
- Call for information: 1-800-991-8109
- Fax: 1-715-221-6616
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Site of Service Office and Outpatient Based Procedure
Prior authorization is required for site of service for P2, P3 and R2 indicators.
Prior notification and approval may be required by Security Health Plan for outpatient procedures (i.e. site of service care requests).- Call for information: 1-800-991-8109
- Fax: 1-715-221-6616
Product line(s):
Commercial
Skilled Nursing Facility Admission
A skilled nursing facility (SNF) primarily furnishes skilled nursing and rehabilitation services performed by or provided under the supervision of licensed nursing personnel or professional therapists.
Prior authorization must be obtained from naviHealth for admissions to and concurrent stays at a skilled nursing facility.
Security Health Plan requires pre-certification from naviHealth for this service.
- Call: 1-855-512-7002
- Fax: 1-855-847-7243
Learn more about skilled nursing facilities prior authorization. Click here for more details about physical and occupational therapy in a skilled nursing facility.
Product line(s):
Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Medicare Medical Savings Account (MSA), Security Administrative Services
Skin Substitute
Skin substitute is a natural product derived from mucosal cells found in the small intestinal walls. It is used mainly in hard to heal non-burn wounds, but can also be used for superficial burn wounds and skin graft sites in donors.
Security Health Plan requires prior authorization for this service. Please complete the form below.
Product line(s):
Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Sleep management in home and outpatient setting
Sleep management for in home and outpatient sleep studies including: Sleep Diagnostics, Pap Therapy Devices and Supplies (DME), Therapy Support.
Security Health Plan requires prior authorization through eviCore for these service:
- Online: log into www.carecorenational.com
- Call: 1-888-444-6185
- Fax: 1-885-511-0403
Click here for more details.
Product line(s):
BadgerCare, Commercial, Medicare Advantage HMO-POS
Spinal Cord Stimulator
Spinal cord stimulator (SCS) consists of a lead which delivers electrical stimulation to the spinal cord, an extension wire which conducts electrical stimulation from the power source to the lead, and a power source which generates the electrical stimulation.
Security Health Plan requires prior authorization through eviCore for this service:
- Online: log into www.carecorenational.com
- Call: 1-888-444-6185
- Fax: 1-800-540-2406
Product line(s):
BadgerCare, Commercial, Medicare Advantage HMO-POS
Step Therapy Override
Step therapy is a pharmaceutical utilization management tool that requires using one or more drugs in a step-wise approach before coverage of the non-preferred drug can be authorized.
In cases when the member requires the step therapy drug as a first-line option and the initial request for drug coverage has been denied due to a step therapy requirement, supporting documentation is requested from the provider. This process does not apply to generic drugs or biosimilars.
To request an exception, please complete the form below.
Product line(s):
Commercial, Family Health Center, Marshfield Clinic Health System
Surgical Treatment for Obesity
Please contact Security Health Plan to determine if a member has coverage for surgical treatment for obesity. If a member has coverage, prior authorization is required.
Security Health Plan requires prior authorization for this service. Please complete the form below.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Swing Bed Admission
A swing bed is a skilled nursing facility (SNF) type of care that is delivered in a hospital or critical access hospital (CAH) that has swing bed (SB) status.
Security Health Plan requires pre-certification for this service.
- Call for information: 1-800-991-8109
- Fax: 1-715-221-6616
Product line(s):
Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Synagis
Synagis® (palivizumab), a monoclonal antibody, is used as a prophylaxis to reduce lower respiratory tract disease caused by respiratory syncytial virus (RSV) in high-risk children.
Security Health Plan requires prior authorization for this service. Members on our Commercial plans, including individual, family or employer-sponsored health care plans, and self-funded groups should go to ih.magellanrx.com.
Please contact Magellan customer service or visit their website:
- Online: ih.magellanrx.com
- Call: 1-800-424-8243
Members with a BadgerCare plan should complete the form below.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Security Administrative Services
Total Hip Replacement
Total hip replacement arthroplasty is a surgical procedure that replaces a worn out or damaged hip with an artificial joint (prosthesis).
Security Health Plan requires prior authorization through eviCore for this service for BadgerCare, Commercial, and Medicare Advantage HMO-POS.
- Online: log into www.evicore.com
- Call: 1-888-444-6185
- Fax: 1-800-540-2406
Security Health Plan requires prior authorization through Security Health Plan for this service for Marshfield Clinic Health System and Security Administrative Services. Complete the form below.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Total Knee Replacement
Total knee arthroplasty is an operation in which a damaged knee joint is surgically replaced with an artificial joint (prosthesis).
eviCore handles prior authorization for Total Knee Replacement.
Security Health Plan requires prior authorization through eviCore for this service for BadgerCare, Commercial, and Medicare Advantage HMO-POS.
- Online: log into www.evicore.com
- Call: 1-888-444-6185
- Fax: 1-800-540-2406
Security Health Plan requires prior authorization through Security Health Plan for this service for Marshfield Clinic Health System and Security Administrative Services. Complete the form below.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Transgender Services
Prior authorization is required for members requesting gender reassignment services. Please contact Security Health Plan to verify benefits and coverage criteria requirements.
Security Health Plan requires prior authorization for this service. Please complete the form below.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Transplants
Organ and stem cell/bone marrow transplantation is a medical procedure in which an organ or cells are removed from one body (or own body) and placed in the body of a recipient, to replace a damaged or missing organ or stem cells/barrow.
All services related to transplants require prior authorization.
Security Health Plan requires prior authorization for this service and pre-certification for admission.
- Call for information: 1-800-991-8109
- Fax: 1-715-221-6616
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services
Vagus Nerve Stimulation for Depression (Effective 1/1/20)
Vagus Nerve Stimulation (VNS) is a type of treatment in which short bursts of electrical energy are directed into the brain via the vagus nerve, a large nerve in the neck.
Security Health Plan requires prior authorization for this service. Please complete the form below.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Security Administrative Services