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Provider Manual

Providers’ Most Frequently Asked Questions

Last Updated on August 28, 2018
  1. How will I know if my patient is covered through Security Health Plan?
    Members are issued a Forward Card. Eligibility must be verified through a point-of-service device, by calling the automated voice response system, or by visiting the ForwardHealth interchange Web site.

  2. How is the BadgerCare Plus Program different from how we have provided care to Security Health Plan members in the past?
    Security Health Plan BadgerCare Plus members choose a primary care provider who will supervise, coordinate, and provide initial and basic care to members; initiate referrals for specialty care; and maintain continuity of patient care.

  3. How can my patients select me as their PCP if they do not have a PCP already?
    If you have questions regarding the eligibility of your patients or wish to assist your patients in selecting you as their PCP, please call 1-800-791-3044 for assistance.

  4. Are second opinions required?
    No, second opinions are not required through the Security Health Plan BadgerCare Plus Program.

  5. Which services will require prior authorization?
    Please see the prior authorization section of this manual for services that require prior authorization.

  6. Do BadgerCare Plus claims need to be separated from other Security Health Plan claims?
    No, claims do not need to be separated, however, BadgerCare Plus provider statements and payments will be separated from group/direct pay claims when you receive them.

  7. What is HealthCheck?
    HealthCheck is the well-child exam for members of the BadgerCare Plus Program who are under age 21. The HealthCheck includes comprehensive health and development history, comprehensive unclothed physical exams, age-appropriate vision and hearing screens, oral assessment with appropriate referral, immunizations, and also assessment and appropriate screening for lead exposure risk at about age 1 and again at age 2. Nutritional assessment and anticipatory guidance are also part of HealthCheck exams.

  8. Which codes and modifiers do I use for HealthCheck claims?
    Please see the HealthCheck section of this manual for the appropriate preventive CPT codes and HealthCheck modifier for accurate billing.

  9. What if my patient needs mental health services?
    Members must seek services from BadgerCare Plus affiliated behavioral health providers.

  10. What number should I call if I have questions regarding BadgerCare Plus?
    Please call Security Health Plan Customer Service at 1-800-791-3044 with questions or concerns.

  11. Who may serve as a PCP?

    • Family practitioners

    • General internists

    • Pediatricians

    • Obstetricians/gynecologists (limited)

    • Physician assistants and nurse practitioners working in primary care

    • Individuals trained as medical subspecialists who are willing to perform all the duties of a primary care provider

  12. What happens when the PCP is unavailable?
    Cross-coverage may be provided by usual backup call arrangement within the practice group. The patient may receive medical services from any PCP within the same group and receive after-hours care from the responsible on-call provider.

  13. Can a Security Health Plan enrollee change PCPs?
    An enrollee wishing to change to a different PCP must call Security Health Plan at 1-800-791-3044.