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Provider Manual

Recent Updates

January 24, 2019

BadgerCare Plus

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus1

Potentially Preventable Readmission (PPR) program

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

Wellness and Health Promotion program

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/care-management/wellness-and-health-promotion

Claim Submission Reminder

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/claims-processing-policies-and-procedures/claim-submission-reminder

CMS 1500 Sample Claim Form & Instructions

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/claims-processing-policies-and-procedures/cms-1500-instructions

Coding Quick Reference

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/claims-processing-policies-and-procedures/coding-quick-reference

Coordination of Benefits

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/claims-processing-policies-and-procedures/coordination-of-benefits

Medicaid propagation logic

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/claims-processing-policies-and-procedures/medicaid-propagation

Non-Covered Services

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/claims-processing-policies-and-procedures/non-covered-services

Order of Benefit Determination

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/claims-processing-policies-and-procedures/order-of-benefit-determination

Provider Validation for Claims Processing

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/claims-processing-policies-and-procedures/provider-validation-for-claims-processing

Reference (outside) Laboratory Billing Protocol

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/claims-processing-policies-and-procedures/reference-outside-laboratory-billing-protocol

Surgery Information

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/claims-processing-policies-and-procedures/surgery-information

When Security Health Plan is primary bill for any service

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/claims-processing-policies-and-procedures/when-security-health-plan-is-primary-bill-for-any-service

Worker's Compensation

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/claims-processing-policies-and-procedures/workers-compensation

ForwardHealth

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/forwardhealth

Billing

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/healthcheck/billing

BadgerCare Plus Member HealthCheck Report

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/healthcheck/clinical-pcp-healthcheck-reports

Other HealthCheck Coding

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/healthcheck/coding

Exam at Community Based Agencies

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/healthcheck/exam-at-community-based-agencies

HealthCheck Exam Documentation

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/healthcheck/exam-documentation

General Information Regarding HealthCheck Exams at Obstetrician (OB) Visits

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/healthcheck/exam-including-prenatal-exam

Outreach

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/healthcheck/outreach

HealthCheck

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/healthcheck/overview

Services

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/healthcheck/services

How to Use the HealthCheck Verification Card (The Pink Card)

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/healthcheck/verification-card

BadgerCare Plus Benefits

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/member-information/badgercare-plus-benefits

Behavioral Health

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/policies-and-procedures/behavioral-health

Emergency Room Procedures

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/policies-and-procedures/emergency-room-procedures

Hospital Observation Admission

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/policies-and-procedures/hospital-observation-admission

Never Event

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/policies-and-procedures/never-event

Nurse On-call and Telemonitor Programs

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/policies-and-procedures/nurse-on-call-and-telemonitor-programs

Optical - Eyewear Order Guidelines

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/policies-and-procedures/optical-eyewear-order-guidelines

Sterilization: Hysterectomy Coverage

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/policies-and-procedures/sterilization-hysterectomy-coverage

Sterilization: Tubaligation or Vasectomy Coverage

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/policies-and-procedures/sterilization-tubaligation-or-vasectomy-coverage

Transportation Services

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/policies-and-procedures/transportation-services

Urgent Care Procedures

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/policies-and-procedures/urgent-care-procedures

Product Overview

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/product-overview/overview

DHS Subcontractor Requirements Between Security Health Plan and Providers/Practices

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/provider-rights-and-responsibilities/dhs-subscontract-requirements

Role of the Affiliated Primary Care Provider

http://www.securityhealth.org:443/enproviders/provider-manual/badgercare-plus/provider-rights-and-responsibilities/primary-care-specialty-care-provider-role

Family Health Center provider manual: Approved Outpatient Procedures

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/approved-outpatient-procedures/approved-outpatient-procedures

Additional Programs

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/care-management/additional-programs

Clinical Practice Guidelines

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/care-management/clinical-practice-guidelines

Programs for Members

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/care-management/programs-for-members

Utilization Management

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/care-management/utilization-management

Wellness and Health Promotion program

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/care-management/wellness-and-health-promotion

Claims Submission Reminder

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/claims-processing-policies-and-procedures/claims-submission-reminder

Coordination of Benefits

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/claims-processing-policies-and-procedures/coordination-of-benefits

Order of benefit determination

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/claims-processing-policies-and-procedures/order-of-benefit-determination

Provider appeal and grievance policy

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/claims-processing-policies-and-procedures/provider-appeal-and-grievance-policy

Reference (Outside) Laboratory Billing Protocol

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/claims-processing-policies-and-procedures/reference-outside-laboratory-billing-protocol

Subrogation

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/claims-processing-policies-and-procedures/subrogation

Workers Compensation

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/claims-processing-policies-and-procedures/workers-compensation

Confidentiality of information

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/important-disclosures/confidentiality-statement

Nondiscrimination statement

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/important-disclosures/nondiscrimination-statement

Claims Processing

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/pharmacy/claims-processing

Drug Formulary

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/pharmacy/drug-formulary

General Exclusions

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/pharmacy/exclusions

Formulary exception requests/pharmacy authorization requests

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/pharmacy/formulary-exception

Generic Substitution

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/pharmacy/generic-substitution

Network Pharmacies

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/pharmacy/network-pharmacies

Over-the-Counter (OTC) Medication Coverage

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/pharmacy/over-the-counter-medication-coverage

Prior Authorization

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/pharmacy/prior-authorization

Step Therapy

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/pharmacy/step-therapy

Tobacco Cessation Coverage

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/pharmacy/tobacco-cessation-coverage

Pharmacy utilization management

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/pharmacy/utilization-management

Ambulance Transportation

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/policies-and-procedures/ambulance-transportation

Chiropractic Benefits

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/policies-and-procedures/chiropractic-benefits

Claims Submisssion Guidelines

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/policies-and-procedures/claims-submisssion-guidelines

Dental/Oral Surgery Benefits

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/policies-and-procedures/dental-oral-surgery-benefits

Hospital Coverage

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/policies-and-procedures/hospital-coverage

Mental Health/AODA

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/policies-and-procedures/mental-health-aoda

Nonaffiliated Provider

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/policies-and-procedures/nonaffiliated-provider

Nurse On-call Program

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/policies-and-procedures/nurse-on-call-program

Outpatient Procedure Benefits

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/policies-and-procedures/outpatient-procedure-benefits

Pharmacy Benefit

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/policies-and-procedures/pharmacy-benefit

Sterilization Procedures

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/policies-and-procedures/sterilization-procedures

Tobacco Cessation

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/policies-and-procedures/tobacco-cessation

Program Overview

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/program-overview/program-overview

Access Standards

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/provider-rights-and-responsibilities/access-standards

Family Health Center Expectation's of Providers

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/provider-rights-and-responsibilities/family-health-center-expectations-of-providers

Provider Credentialing Process

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/provider-rights-and-responsibilities/provider-credentialing-process

Provider Reporting of Member Complaints

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/provider-rights-and-responsibilities/provider-reporting-of-member-complaints

Providers' Expectation of Family Health Center

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/provider-rights-and-responsibilities/providers-expectation-of-family-health-center

Northwood to manage DMEPOS services

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/utilization-management/northwood

Second Opinion

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/utilization-management/second-opinion

Technology Assessment

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center/utilization-management/technology-assessment

Family Health Center

http://www.securityhealth.org:443/enproviders/provider-manual/family-health-center1

Transition Care Management

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/care-management/transition-care-management

Wellness and Health Promotion program

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/care-management/wellness-and-health-promotion

Clean Submission Reminder

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/claims-processing-and-policies/clean-submission-reminder

Coordination of Benefits

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/claims-processing-and-policies/coordination-of-benefits

Non-Covered Services

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/claims-processing-and-policies/non-covered-services

Order of Benefit Determination

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/claims-processing-and-policies/order-of-benefit-determination

Multiple Surgeries

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/claims-processing-and-policies/surgery-information

Workers' Compensation

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/claims-processing-and-policies/workers-compensation

State of Wisconsin employees

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/employee-trust-fund/state-of-wisconsin-employees

ID Card Sample

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/member-information/id-card-sample

Pharmacy claims processing

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/pharmacy/claims-processing

Drug Formulary

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/pharmacy/drug-formulary

General Exclusions

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/pharmacy/exclusions

Formulary Exception Requests - Pharmacy Authorization Requests

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/pharmacy/formulary-exception-requests-pharmacy-authorization-requests

Generic Substitution

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/pharmacy/generic-substitution

Over-the-Counter Medication Coverage

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/pharmacy/over-the-counter-medication-coverage

Prior Authorization

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/pharmacy/prior-authorization

Step Therapy

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/pharmacy/step-therapy

Tablet Splitting Incentive Option

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/pharmacy/tablet-splitting-incentive-option

Tobacco Cessation Coverage

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/pharmacy/tobacco-cessation-coverage

Pharmacy utilization management (UM)

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/pharmacy/utilization-management

Ambulance Transportation

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/policies-and-procedures/ambulance-transportation

Audiology Services

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/policies-and-procedures/audiology-services

Autism Mandate

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/policies-and-procedures/autism-mandate

Behavioral Health

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/policies-and-procedures/behavioral-health

Benefit Policies

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/policies-and-procedures/benefit-policies

Chiropractic Care

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/policies-and-procedures/chiropractic-care

Dental Accidents

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/policies-and-procedures/dental-accidents

Dental - Oral Surgery

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/policies-and-procedures/dental-oral-surgery

Diet Therapy Guidelines

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/policies-and-procedures/diet-therapy-guidelines

Durable Medical Equipment - Home Respiratory Equipment

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/policies-and-procedures/durable-medical-equipment-home-respiratory-equipment

Emergency Medical Care Services

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/policies-and-procedures/emergency-medical-care-services

Medical Underwriting

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/policies-and-procedures/medical-underwriting

Never Events

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/policies-and-procedures/never-events

Nurse On Call and Telemonitor Programs

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/policies-and-procedures/nurse-on-call-and-telemonitor-programs

Second Opinion

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/policies-and-procedures/second-opinion

Temporomandibular Disorder

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/policies-and-procedures/temporomandibular-disorder

Vision Care

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/policies-and-procedures/vision-care

Product Overview

http://www.securityhealth.org:443/enproviders/provider-manual/group-and-direct-pay/product-overview/overview

Authorization of inpatient care

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/benefit-information/authorization-of-inpatient-care

Benefit Explanation

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/benefit-information/benefit-explanation

Continuity and coordination in care

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/benefit-information/continuity-and-coordination-in-care

Coverage Specifics for Certain Services

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/benefit-information/coverage-specifics-for-certain-services

Dental services covered as a supplemental benefit

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/benefit-information/dental-benefits

Depression in Primary Care Guidelines

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/benefit-information/depression-in-primary-care-guidelines

Emergency and Urgently Needed Care Coverage

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/benefit-information/emergency-and-urgently-needed-care-coverage

Home INR monitoring

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/benefit-information/home-inr-monitoring

Mental Health Medication Management

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/benefit-information/mental-health-medication-management

Psychological Testing

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/benefit-information/psychological-testing

Security Health Plan Copayment Structure

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/benefit-information/security-health-plan-copayment-structure

Additional Programs

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/care-management/additional-programs

Advanced Directive Policy

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/care-management/advanced-directive-policy

Medicare Advantage Coverage Inquiry for Organization Determination Process

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/care-management/coverage-determination

Covered Benefits

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/care-management/covered-benefits

End Stage Renal Disease Care Coordination

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/care-management/end-stage-renal-disease-care-coordination

Health Risk Assessment

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/care-management/health-risk-assessment

Hospice Care Coordination

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/care-management/hospice-care-coordination

Hospital Inpatient Utilization Review

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/care-management/hospital-inpatient-utilization-review

Medicare Outpatient Observation Notice (MOON)

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/care-management/medicare-outpatient-observation-notice

Notice of Medicare Noncoverage

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/care-management/notice-of-medicare-noncoverage

Outpatient Observation Frequently Asked Questions

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/care-management/outpatient-observation-frequently-asked-questions

Precertification Notification and Concurrent Review

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/care-management/precertification-notification-and-concurrent-review

Prior Authorization for Nonaffiliated Providers

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/care-management/prior-authorization-for-nonaffiliated-providers

Two Midnight Rule

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/care-management/two-midnight-rule

Wellness and Health Promotion program

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/care-management/wellness-and-health-promotion

Billing and Reporting

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/claims-processing-policies-and-procedures/billing-and-reporting

Coordination of Benefits

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/claims-processing-policies-and-procedures/coordination-of-benefits

Medicare Advantage Coverage Determination Request

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/claims-processing-policies-and-procedures/medicare-advantage-coverage-determination

Order of Benefit Determination

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/claims-processing-policies-and-procedures/order-of-benefit-determination

Payment Issues

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/claims-processing-policies-and-procedures/payment-issues

Workers' Compensation

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/claims-processing-policies-and-procedures/workers-compensation

Provider Responsibilities Regarding Medicare Advantage Member Appeal

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/member-information/appeals-grievance

Customer Service Representatives

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/member-information/customer-service-representatives

Eligibility and Enrollment

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/member-information/eligibility-and-enrollment

ID Cards

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/member-information/id-cards

Appeals process

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/pharmacy/appeal-process

Coverage Determination

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/pharmacy/coverage-determination

Exception process

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/pharmacy/formulary-exception-requests-pharmacy-authorization-requests

Prior Authorization

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/pharmacy/prior-authorization

Anti-Kickback Statute

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/primary-care-provider/anti-kickback-statute

Compliance - Fraud, Waste and Abuse

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/primary-care-provider/compliance-fraud-waste-and-abuse

Documentation of Care

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/primary-care-provider/documentation-of-care

Model of Care

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/primary-care-provider/model-of-care

Notice of Personal Provider Status Change

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/primary-care-provider/notice-of-personal-provider-status-change

The False Claims Act

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/primary-care-provider/the-false-claims-act

Ally Rx D-SNP Model of Care Summary

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/product-overview/ally-rx-d-snp-model-of-care

Discussion of Disenrollment from Medicare Advantage

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/product-overview/discussion-of-disenrollment-from-medicare-advantage

Encounter Data Policy

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/product-overview/encounter-data-policy

Medicare Advantage Part D Data Submissions

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/product-overview/medicare-advantage-part-d-data-submissions

Medicare Advantage Part D Reporting Requirements

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/product-overview/medicare-advantage-part-d-reporting-requirements

Medicare Advantage Reporting Requirements

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/product-overview/medicare-advantage-reporting-requirements

Recipient of Federal Funds Policy

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/product-overview/recipient-of-federal-funds-policy

What are Medicare Advantage plans?

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/product-overview/what-are-medicare-advantage-plans

Prohibition of Interference with Health Care Professionals' Advice to Medicare Advantage Members

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/provider-rights-and-responsibilities/prohibition-of-interference-with-health-care-professionals-advice-to-medicare-advantage-members

Provider Contracting

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/provider-rights-and-responsibilities/provider-contracting

Skilled Nursing Facility Denial of Medicare/Medicaid Payment

http://www.securityhealth.org:443/enproviders/provider-manual/medicare-advantage/provider-rights-and-responsibilities/skilled-nursing-facility

Recent Updates

http://www.securityhealth.org:443/enproviders/provider-manual/recent-updates

Additional Programs

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/care-management/additional-programs

Chronic Care Management

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/care-management/chronic-care-management

Clinical Practice Guidelines

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/care-management/clinical-practice-guidelines

National Committee for Quality Assurance

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/care-management/national-committee-for-quality-assurance

Preventive Service Guidelines

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/care-management/preventive-service-guidelines

Programs for Members

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/care-management/programs-for-members

Quality Improvement/Utilization Management Program Overview

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/care-management/quality-improvement-utilization-management-program-overviewmanual-detail

Second Opinion

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/care-management/second-opinion

Security Health Plan Protocols

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/care-management/security-health-plan-protocols

Technology Assesment

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/care-management/technology-assesment

Utilization Management

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/care-management/utilization-management

Behavior Health

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/care-management/utilization-management-for-behavior-health

Utilization Management Timeliness Standards

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/care-management/utilization-management-for-timeliness-standards

Claims Adjustment Reason Code

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/claims-adjustment-reason-code

Claims Coding Resources

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/claims-coding-resources

Claim Status Definitions

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/claim-status-definitions

CMS 1500 Sample Claim Form and Instructions

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/cms-1500-instructions

Coding Quick Reference

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/coding-quick-reference

Coordination of Benefits

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/coordination-of-benefits

Corrected Claim or Adjustment Requests

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/correction-adjustment-request

Data security and confidentiality

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/data-security-and-confidentiality

Electronic claims

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/electronic-claims

Electronic file submission process

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/electronic-file-submission-process

Filing limits, Clean Claim and Interest Payments

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/filing-limits-clean-claim-interest-payments

ICD-10 Implementation

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/icd-10-implementation

Limitation of liability

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/limitation-of-liability

Modifier information

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/modifiers

National Correct Coding

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/national-correct-coding

Output reports

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/output-reports

Provider appeal and grievance policy

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/provider-appeal-and-grievance-policy

Provider Remittance Advice Statement

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/provider-remittance-advice-statement

Physician Billing for the Lab Service

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

Reimbursement statement example

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/reimbursement-statement-example

Risk Adjustment - Basics

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

Risk Adjustment - Behavioral health disorders

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

Risk Adjustment - Cancer

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

Risk Adjustment - Cardiovascular conditions

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

Risk Adjustment - Diabetes

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

Risk Adjustment and Hierarchical Condition Category Coding

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

Risk Adjustment - Kidney disease

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

Risk Adjustment - Neurological conditions

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

Risk Adjustment - Pulmonary disease

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

Subrogation

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/subrogation

Claims Submission Test File Procedure

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/testing-procedures

Trading partner for electronic data interchanges

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/trading-partner-for-electronic-data

Transaction terms

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/transaction-terms

Transmission

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/transmission

UB-04 Instructions and Sample Claim Form

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/ub-04-instructions-and-sample-claim-form

UB-04 Sample Claim Form

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/ub-04-sample-claim-form

Ulcers and Wounds

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

Workers' Compensation

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/claims-processing-policies-and-procedures/workers-compensation

Confidentiality of information

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/confidentiality-statement/confidentiality-statement

Nondiscrimination statement

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/important-disclosures/nondiscrimination-statement

Member Handbook/Evidence of Coverage

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/member-information/member-handbook-evidence-of-coverage

Interactive Formulary

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/pharmacy/formulary

Medical pharmacy prior authorization

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

Provider Directory

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

Access Standards

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

Documentation of Care

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/provider-rights-and-responsibilities/documentation-of-care

Medical Record Documentation Standards

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/provider-rights-and-responsibilities/medical-record-documentation-standards

Provider Credentialing Process

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/provider-rights-and-responsibilities/provider-credentialing-process

Provider Reporting of Member Complaints

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/provider-rights-and-responsibilities/provider-reporting-of-member-complaints

Providers Expectations of Security Health Plan

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/provider-rights-and-responsibilities/providers-expectations-of-security-health-plan

Security Health Plans Expectations of Providers

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/provider-rights-and-responsibilities/security-health-plans-expectations-of-providers

Home IV Drug Therapies

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

Hospice Protocols

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/utilization-management/hospice-protocol

Hospital Observation Admission

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/utilization-management/hospital-observation-admission

Inpatient Rehabilitation - Acute

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/utilization-management/inpatient-rehabilitation-acute

Northwood to manage DMEPOS services

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/utilization-management/northwood

Prior Authorization of Outpatient Physical Therapy, Occupational Therapy and Speech Therapy

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/utilization-management/outpatient-physical-speech-occupational-therapy

Physical, Speech and Occupational Therapy - Outpatient

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/utilization-management/physical-speech-and-occupational-therapy-outpatient

Precertification and Concurrent Review

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/utilization-management/pre-certification-notification-and-concurrent-review-guide

Prior Authorization for Nonaffiliated Providers

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/utilization-management/prior-authorization-for-nonaffiliated-providers

Services related to oral appliances – for treatment of obstructive sleep apnea

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/utilization-management/services-related-to-oral-appliances

Physical Speech and Occupational Therapy - Outpatient

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/utilization-management/skilled-nursing-facility-care

January 28, 2019

Contact information

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/contact-information/contact-information

February 08, 2019

Medical Polices

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/provider-rights-and-responsibilities/medical-polices

High end imaging and radiation services

http://www.securityhealth.org:443/enproviders/provider-manual/shared-content/utilization-management/high-end-imaging-and-radiation-services