Prior Authorization (PA) / Notification requirements
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 on the right.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Acute Rehabilitation Admission
Security Health Plan requires pre-certification 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
Click here for more information on skilled nursing facility care.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, State of Wisconsin Employee Trust Fund
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. Contact Security Health Plan at 1-800-991-8109 for questions regarding prior authorization for this service.
Security Health Plan requires prior authorization for this service. Please call 1-800-991-8109 or fax all relevant information to 715-221-6616.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Amino Acid Formula
Oral amino acid-based infant formula (e.g., Neocate, Elecare, Nutramigen AA) requires prior authorization.
Security Health Plan requires prior authorization for this service. Please complete the form on the right.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System
Autologous Cultured Chondrocytes
Autologous cultured chondrocytes, also known as Carticel, 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 for this drug. Please call 1-800-548-1224.
Product line(s):
Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
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 on the right.
Product line(s):
BadgerCare, Commercial, Family Health Center, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Cardiac Valve Replacement
Cardiac Valve Replacement is an open heart operation to remove the damaged valve and replace with a new artificial (prosthetic) valve.
Security Health Plan requires prior authorization for this service. Please complete the form on the right.
Product line(s):
Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, State of Wisconsin Employee Trust Fund
Carpal Tunnel - Median Neuropathy - Specialty Consult
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 Shared decision-making ONLY for State of Wisconsin Employee Trust Fund (ETF) members. Please complete the form on the right.
Product line(s):
State of Wisconsin Employee Trust Fund
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 pre-certification and certain criteria must be met to receive approval for this service.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Chronic Hip Pain - Osteoarthritis - Specialty Consult
Referral to an orthopedic surgeon is required for chronic hip pain.
Security Health Plan requires prior authorization and Shared decision-making ONLY for State of Wisconsin Employee Trust Fund (ETF) members. Please complete the form on the right.
Click here for more details.
Product line(s):
State of Wisconsin Employee Trust Fund
Chronic Knee Pain - Osteoarthritis or Meniscal Degeneration - Specialty Consult
Referral to an orthopedic surgeon is required for chronic knee pain.
Security Health Plan requires prior authorization and Shared decision-making ONLY for State of Wisconsin Employee Trust Fund (ETF) members. Please complete the form on the right.
Click here for more details.
Product line(s):
State of Wisconsin Employee Trust Fund
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. Please call 1-800-991-8109 or fax all relevant information to 715-221-6616.
Product line(s):
Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Continuous Glucose Monitoring
Security Health Plan considers a continuous glucose monitoring system (CGMS) a “stand-alone” system. This prior authorization is for services performed in the office setting only. A CGMS used with an insulin pump does not apply to this form.
Security Health Plan requires prior authorization for this service. Please complete the form on the right.
Product line(s):
BadgerCare, Commercial, Family Health Center, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Core Decompression
When osteonecrosis of the hip is diagnosed early, core decompression is often successful in preventing collapse of the femoral head and the development of arthritis.
Security Health Plan requires prior authorization for this service. Please complete the form on the right.
Product line(s):
BadgerCare, Commercial, Family Health Center, Marshfield Clinic Health System, Medicare Advantage HMO-POS
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. Please call 1-800-991-8109 or fax all relevant information to 715-221-6616.
Product line(s):
BadgerCare, Commercial, Family Health Center, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Durable Medical Equipment - Prosthetic - Orthotic Suppliers
A provider must submit the prior authorization for durable medical equipment (DME) to Northwoods. 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.
- Online: www.northwoodinc.com/security-health-plan/
- Call: 1-888-532-1344
- Fax: 1-866-483-9988
- Provider Portal for entities contracted with Northwood: https://providerportal.northwoodinc.com
You may need to search for contracts under Security Health Plan and Security Administrative Services on the Northwoods 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)
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. Please call 1-800-991-8109 or fax all relevant information to 715-221-6616.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Electrical Stimulation and Electromagnetic Therapy - Service
Electrical stimulation: is the application of electrical current through electrodes placed directly on the skin in close proximity to the wound. Electromagnetic therapy: is a type of therapy involves the placement of electrodes or electromagnetic waves creating an electric current that passes through the wound. It is thought that electrical current will speed wound healing.
Security Health Plan requires prior authorization for this service. Please complete the form on the right.
Product line(s):
BadgerCare, Commercial, Family Health Center, Marshfield Clinic Health System, Medicare Advantage HMO-POS
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. Please call 1-800-991-8109 or fax all relevant information to 715-221-6616.
Product line(s):
BadgerCare, Commercial, Family Health Center, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Fecal Transplant
Fecal microbiota transplant (FMT) is a procedure in which fecal matter, or stool, is collected from a tested donor, mixed with a saline or other solution, strained, and placed in a patient, by colonoscopy, endoscopy, sigmoidoscopy, or enema.
Security Health Plan requires prior authorization for this service. Please call 1-800-991-8109 or fax all relevant information to 715-221-6616.
Product line(s):
Commercial, Marshfield Clinic Health System
Femoroacetabular Impingement Surgery
Femoracetabular Impingement Surgery is a surgical procedure to improve range of movement and reduce pain.
Security Health Plan requires prior authorization for this service. Please complete the form on the right.
Product line(s):
Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, State of Wisconsin Employee Trust Fund
Genetic Testing
Genetic testing, used to detect mutations in genes associated with “familial medical conditions”, is performed to determine whether an individual has inherited a mutated version of the gene.
Security Health Plan requires prior authorization for this service. Please complete the form on the right.
Product line(s):
BadgerCare, Commercial, Family Health Center, Marshfield Clinic Health System
High-end Imaging Services - CT Scan
eviCore handles prior authorization of all high-end imaging services. HEI include MRI, PET, CT and Nuclear Cardiac Services.
Security Health Plan requires prior authorization from eviCore for this service.
- Online: log into www.medsolutionsonline.com
- Call: 1-888-693-3211
- Fax: 1-888-693-3210
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
High-end Imaging Services - Low Dose CT for Lung Cancer Screening
eviCore handles prior authorization of all high-end imaging services. HEI include MRI, PET, CT and Nuclear Cardiac Services.
Security Health Plan requires prior authorization from eviCore for this service.
- Online: log into www.medsolutionsonline.com
- Call: 1-888-693-3211
- Fax: 1-888-693-3210
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
High-end Imaging Services - MRA
eviCore handles prior authorization of all high-end imaging services. HEI include MRI, PET, CT and Nuclear Cardiac Services.
Security Health Plan requires prior authorization from eviCore for this service.
- Online: log into www.medsolutionsonline.com
- Call: 1-888-693-3211
- Fax: 1-888-693-3210
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
High-end Imaging Services - MRI
eviCore handles prior authorization of all high-end imaging services. HEI include MRI, PET, CT and Nuclear Cardiac Services.
Security Health Plan requires prior authorization from eviCore for this service.
- Online: log into www.medsolutionsonline.com
- Call: 1-888-693-3211
- Fax: 1-888-693-3210
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
High-end Imaging Services - PET
eviCore handles prior authorization of all high-end imaging services. HEI include MRI, PET, CT and Nuclear Cardiac Services.
Security Health Plan requires prior authorization from eviCore for this service.
- Online: log into www.medsolutionsonline.com
- Call: 1-888-693-3211
- Fax: 1-888-693-3210
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
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 on the right.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Home Infusion - Chemotherapy
Security Health Plan requires prior authorization for this service. Please complete the form on the right.
Click here for more details.
Product line(s):
BadgerCare, Commercial, Family Health Center, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Home Infusion - IVSQ Immunoglobulins
Immune globulin is a sterile, purified preparation of human immunoglobulin derived from pooled human plasma from thousands of donors. Consisting primarily of immunoglobulin G, one of five classes of immunoglobulin (Ig), each batch of immune globulin provides immunomodulating peptides and antibodies against most exogenous antigens, many normal human proteins, and Fab, the antigen-binding region of autoantibodies. All currently available products contain high concentrations of IgG with subclass distribution corresponding to that of normal serum.
Click here for more details.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Home Infusion - Other IV Infusion
This prior authorization includes TPN and hydration.
Click here for more details.
Security Health Plan requires prior authorization for this service. Please complete the form on the right.
Product line(s):
BadgerCare, Commercial, Family Health Center, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Home Infusion - Parenteral Nutrition
Total parenteral nutrition (TPN) peripheral parenteral nutrition (PPN) are a provision of daily nutrients and caloric requirements provided intravenously to a patient who is unable to receive nutritional intake via oral or tube feeding.
Click here for more details.
Security Health Plan requires prior authorization for this service. Please complete the form on the right.
Product line(s):
BadgerCare, Commercial, Family Health Center, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Hospice
Hospice services can be provided either inpatient or at home. Hospice is specific care, such as pain management, provided to a member whose life expectancy, as certified by a physician, is six months or less.
Security Health Plan requires prior authorization for this service. Please call 1-800-991-8109 or fax all relevant information to 715-221-6616. To determine if this prior authorization applies to your patient, call 1-800-548-1224.
Product line(s):
Commercial, Marshfield Clinic Health System
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. Please call 1-800-991-8109 or fax all relevant information to 715-221-6616.
Click here for more details.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Hospital Observation Admission
Security Health Plan requires prior notification for this service. Please call 1-800-991-8109 or fax all relevant information to 715-221-6616.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
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.
Click here for more details about the hyaluronic acids
Product line(s):
Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, State of Wisconsin Employee Trust Fund
Hysterectomies for Diagnosis of Fibroids
Prior authorization is required for both inpatient and outpatient procedures only for leiomyoma (fibroids).
Security Health Plan requires prior authorization and Shared decision-making ONLY for State of Wisconsin Employee Trust Fund (ETF) members. Please complete the form on the right.
Click here for more details.
Product line(s):
State of Wisconsin Employee Trust Fund
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 for this service. Please complete the form on the right.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Intrastromal Corneal Ring Segments
The device (INTACS) is indicated for the reduction or elimination of myopia and astigmatism in patients with keratoconus, who are no longer able to achieve adequate vision with their contact lenses or spectacles, so that their functional vision may be restored and the need for a corneal transplant procedure may potentially be deferred.
Security Health Plan requires prior authorization for this service. Please complete the form on the right.
Product line(s):
Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Intravenous Iron Therapy
Iron infusion is a procedure in which iron is delivered to your body intravenously. Effective June 1, 2018, 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 on the right.
Product line(s):
Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, State of Wisconsin Employee Trust Fund
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 for this service. Please complete the form on the right.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Lipectomy
Lipectomy is the excision of fatty tissue.
Security Health Plan requires prior authorization for this service. Please complete the form on the right.
Product line(s):
BadgerCare, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Long Term Acute Care Admission
LTAC (Long-term acute care) initial reviews are reviewed by naviHealth prior to admission to the facility.
Security Health Plan requires pre-certification from naviHealth for this service.
- Call: 855-512-7002
- Fax: 855-847-7243
Click here for more details on long term acute care.
Click here for more information on skilled nursing facility care.
Product line(s):
Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Low Back Pain - Orthopedic or Neurosurgery - Specialty Consult
Referral to an orthopedic surgeon, neurosurgeon for low back pain.
Security Health Plan requires prior authorization and Shared decision-making ONLY for State of Wisconsin Employee Trust Fund (ETF) members. Please complete the form on the right.
Click here for more details.
Product line(s):
State of Wisconsin Employee Trust Fund
Lung Volume Reduction Surgery
Lung volume reduction surgery (LVRS) is a general term encompassing a variety of surgical procedures that are offered to alleviate the symptoms of advanced chronic obstructive pulmonary disease (COPD).
Security Health Plan requires prior authorization for this service. Please complete the form on the right.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
MAZE procedure
The maze procedure is a surgical treatment for atrial fibrillation.
Security Health Plan requires prior authorization for this service. Please complete the form on the right.
Product line(s):
Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, State of Wisconsin Employee Trust Fund
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 on the right.
Product line(s):
Medicare Advantage HMO-POS, Medicare Medical Savings Account (MSA)
Non-affiliated Providers Request
Security Health Plan requires prior authorization for services received by non-affiliated providers. Please complete the form on the right.
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. Please call 1-800-991-8109 or fax all relevant information to 715-221-6616.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
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 on the right.
Product line(s):
BadgerCare, Commercial, Family Health Center, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Outpatient Therapy Treatment Concurrent
A request for concurrent therapy treatment is required for any additional services needed after the initial services have been approved.
Security Health Plan requires prior authorization for this service. Please complete the form on the right and fax to 715-221-6616.
Click here for more details on physical, speech and occupational therapy.
Product line(s):
Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
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.
Security Health Plan requires prior authorization for this service. Please complete the form on the right.
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 on the right.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Pharmaceuticals - Specialty Medications Magellan
Security Health Plan requires prior authorization from Magellan Rx for medical pharmacy medications.
- Call: 800-424-8243
- Online: ih.magellanrx.com
Click here for more details.
Product line(s):
Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, State of Wisconsin Employee Trust Fund
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 on the right.
Product line(s):
BadgerCare, Commercial, Family Health Center, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Radiation Oncology Services
Radiation oncology requires prior authorization. Contact eviCore at 1-888-665-8341.
Security Health Plan requires prior authorization from eviCore for this service.
- Online: log into www.carecorenational.com
- Call: 1-888-444-6185
Click here for more details.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Radicava
Radicava is an intravenous medication used to help with recovery following a stroke and to treat amyotrophic lateral sclerosis.
Effective June 1, 2018, Security Health Plan requires prior authorization for this service. Please complete the form on the right.
Product line(s):
Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, State of Wisconsin Employee Trust Fund
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 on the right.
Product line(s):
BadgerCare, Commercial, Family Health Center, Marshfield Clinic Health System, Medicare Advantage HMO-POS
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 on the right.
Product line(s):
BadgerCare, Commercial, Family Health Center, Marshfield Clinic Health System, Medicare Advantage HMO-POS
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. Please call 1-800-991-8109 or fax all relevant information to 715-221-6616.
Click here for more details.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System
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 on the right.
Product line(s):
BadgerCare, Commercial, Family Health Center, Marshfield Clinic Health System, Medicare Advantage HMO-POS
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. Please call 1-800-991-8109 or fax all relevant information to 715-221-6616.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
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). Please call 1-800-991-8109 or fax all relevant information to 715-221-6616.
Product line(s):
Commercial, Marshfield Clinic Health System
Skilled Nursing Facility Admission
Prior authorization must be obtained from naviHealth for admissions to and concurrent stays at a skilled nursing facility. 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.
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.
Product line(s):
Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, Medicare Medical Savings Account (MSA)
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 on the right.
Product line(s):
Commercial, Marshfield Clinic Health System, 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 for this service. Please complete the form on the right.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
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 on the right.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Swing Bed Admission
All swing bed admissions must be prior authorized. 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. Please call 1-800-991-8109 or fax all relevant information to 715-221-6616.
Product line(s):
Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Synagis - Medicaid
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, should go to ih.magellanrx.com. Members with a BadgerCare plan should complete the form on the right.Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System
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 for this service. Please complete the form on the right.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Total Knee Replacement
Total knee arthroplasty is an operation in which a damaged knee joint is surgically replaced with an artificial joint (prosthesis).
Security Health Plan requires prior authorization for this service. Please complete the form on the right.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
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 on the right.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS, State of Wisconsin Employee Trust Fund
Transplants
All services related to transplants require prior authorization.
Security Health Plan requires prior authorization for this service and pre-certification for admission. Please call 1-800-991-8109 or fax all relevant information to 715-221-6616.
Product line(s):
BadgerCare, Commercial, Marshfield Clinic Health System, Medicare Advantage HMO-POS
Wearable Hearing Aids
Security Health Plan requires prior authorization for this service for members over the age of 18. Please complete the form on the right.
To determine if prior authorization for this service applies to your patient, call 1-800-548-1224.
Product line(s):
Commercial, Marshfield Clinic Health System