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Provider Manual

Urgent Care and Emergency Room

Last Updated on May 22, 2021

Security Health Plan and Marshfield Clinic Health System partner together to offer members the 24-hour Nurse Line & Care My Way®

  • Click here for information on the Marshfield Clinic Health System 24-hour Nurse Line
  • Click here for information on Marshfield Clinic’s Care My Way®

Urgent Care and Emergency Room care received in the state of Wisconsin

Outpatient emergency room (ER) and urgent services, when performed in an urgent care setting, do not require prior authorization if received in the state of Wisconsin. All providers must be Wisconsin Medicaid certified.

ER and urgent care services resulting in an inpatient admission or observation stay of longer than 48 hours require precertification/prior authorization. Please call Security Health Plan Health Services at 1-800-991-8109 to start the prior authorization process.

The urgent care doctor should refer the member to his/her PCP for ongoing follow-up care. Any follow-up care performed by a non-affiliated provider requires prior authorization. Providers are encouraged to remind members to use their PCP during regular business hours for non-urgent care needs.

Emergency care received outside the State of Wisconsin

Emergency care outside of the state of Wisconsin is limited to providers who are licensed in the United States and its territories, Mexico and Canada. Per the Wisconsin Administrative code HFS 107.03: Services not covered include services provided to recipients when outside the United States, except Canada and Mexico. Provider must already be or willing to become Wisconsin Medicaid certified. Reimbursement for services received out of Wisconsin are limited to Wisconsin Medicaid rates.

Enrollment options for out-of-state providers: https://www.forwardhealth.wi.gov/WIPortal/Subsystem/Certification/EnrollmentCriteria.aspx?topic=13