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Provider Manual

Recent Updates

October 16, 2018

Potentially Preventable Readmission (PPR) program

https://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/care-management/potentially-preventable-readmission-program

Medical pharmacy prior authorization

https://www.securityhealth.org:443/enproviders/provider-manual/shared-content/pharmacy/medications-that-require-prior-authorization

October 15, 2018

Physician Billing for the Lab Service

https://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/reference-outside-laboratory-billing-protocol

September 30, 2018

Risk Adjustment - Basics

https://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/risk-adjustment-basics

Risk Adjustment - Behavioral health disorders

https://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/risk-adjustment-behavioral-health-disorders

Risk Adjustment - Cancer

https://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/risk-adjustment-cancer

Risk Adjustment - Cardiovascular conditions

https://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/risk-adjustment-cardiovascular-conditions

Risk Adjustment - Diabetes

https://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/risk-adjustment-diabetes

Risk Adjustment and Hierarchical Condition Category Coding

https://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/risk-adjustment-hcc-coding

Risk Adjustment - Kidney disease

https://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/risk-adjustment-kidney-disease

Risk Adjustment - Neurological conditions

https://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/risk-adjustment-neurological-conditions

Risk Adjustment - Pulmonary disease

https://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/risk-adjustment-pulmonary-disease

Ulcers and Wounds

https://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/ulcers-and-wounds

September 19, 2018

Provider Directory

https://www.securityhealth.org:443/enproviders/provider-manual/shared-content/provider-directory/provider-directory

Home IV Drug Therapies

https://www.securityhealth.org:443/enproviders/provider-manual/shared-content/utilization-management/home-iv-drug-therapies

September 24, 2018

Access Standards

https://www.securityhealth.org:443/enproviders/provider-manual/shared-content/provider-rights-and-responsibilities/access-standards