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Utilization Management
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Acute Rehab AdmissionAuthorization of Inpatient CareeviCoreGeneral informationHigh End Imaging - Cardiac studies and elective heart catheterizationHigh End Imaging - Radiation ServicesHome IV Drug TherapiesHospital Admissions - Pre-certificationHospital Inpatient Utilization ReviewHospital Observation AdmissionHysterectomies for Diagnosis of FibroidsLong Term Acute Care AdmissionMusculoskeletal proceduresNaviHealthNorthwoodPharmaceuticals - Specialty Medications (Magellan)Physical, Speech and Occupational Therapy - OutpatientPre-Certification Notification and Concurrent Review GuidePrior Authorization for Nonaffiliated ProvidersPrior authorizationsProvider AppealRadiation Oncology ServicesSecond OpinionServices Related to Oral AppliancesSkilled Nursing Facility AdmissionSleep managementUtilization Management for Behavior HealthUtilization Management for Timeliness Standards
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Benefit Information
Prior Authorization for Nonaffiliated Providers
Last Updated on August 28, 2018
If an affiliated provider believes that a Security Health Plan member needs to see a different provider who is not affiliated with Security Health Plan, he/she must call Security Health Plan for approval prior to referring the member’s visit with the nonaffiliated provider. If Security Health Plan does not approve the referral, services with the nonaffiliated provider will not be covered and the member may be responsible for paying all costs associated with or related to the visit.
Contact Security Health Plan Health Services Department at 1-800-791-3044 before assuring the member of a referral. The coordinator will need the following information:
- Member name and member identification number
- Provider and/or facility the member is being referred to
- Service being requested (for example, consult only, initiate treatment, or assume ongoing care) The referral request may also be submitted on the Nonaffiliated Prior Authorization form found at the end of this section
- The Prior Authorization may also be requested electronically via the Provider Portal
The Security Health Plan Medical Director will consider approval for services from a nonaffiliated provider only if ALL of the following requirements are met:
- The services are medically necessary
- The services are a covered benefit
- The services are not available from an affiliated provider
- The services are received from a Security Health Plan approved referral provider
Click here to download the Nonaffiliated Provider Services Prior Authorization Request form.
IPPS hospital responsibility
- The IPPS hospital will implement a patient safety policy to address never events and provide such policy to Security Health Plan upon request.
- The IPPS hospital will bill Security Health Plan for services related to never events. The bill will notify Security Health Plan that a never event has occurred and such notice will initiate Security Health Plan’s procedures, as described above.
- The IPPS hospital is encouraged to apologize to the patient and her/his family for the never event, as may be appropriate.