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Provider Manual

Workers' Compensation

Last Updated on August 28, 2018
  • Security Health Plan does not cover the cost of services covered by Workers’ Compensation. Claims that are determined to be work-related 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 payment from Workers’ Compensation, the provider should complete an adjustment request form and submit it with 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. 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. Security Health Plan may pursue directly with Workers’ Compensation or an attorney if one has been retained.
  • 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.