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Provider Manual

Workers' Compensation

Last Updated on June 22, 2020
  • Security Health Plan does not cover the cost of services that are determined to be work-related. Claims will be denied using ANSI code 19. The denial reason will print on the provider’s reimbursement statement. Claims must be submitted to the Workers’ Compensation carrier first. 
  • If claims have already been paid by Security Health Plan, related charges will be reversed. The adjustment will be reflected on the provider’s reimbursement statement, using ANSI 19. 
  • If the provider is overpaid due to a payment by the Workers’ Compensation carrier, the provider should submit a copy of the original claim and a copy of the Explanation of Benefits from the Workers’ Compensation carrier. Security Health Plan will reverse charges and the adjustment will be reflected on the provider’s reimbursement statement. 
  • If the Workers’ Compensation carrier denies a claim, Security Health Plan will consider payment if a copy of the denial is attached. The provider must submit claims within 180 days from the date on the Workers’ Compensation carrier denial. 
    • Upon notification that a member is pursuing a workers’ compensation court case, Security Health Plan will also enforce the workers’ compensation exclusion of the member’s benefit policy. 
      • Security Health Plan will reverse charges as allowed by the provider contract.  The adjustment will be reflected on the provider’s reimbursement statement, using ANSI 19.
      • For charges that Security Health Plan may not reverse, due to the provider contract, Security Health Plan may pursue those charges directly with Workers’ Compensation or an attorney.  See the Subrogation page of the provider manual. 
  • If the provider has any questions regarding Workers’ Compensation, please call 715-221-9503 or 1-800-548-4831, Monday through Friday between 8 a.m. and 4:30 p.m. or email shpcob@securityhealth.org.