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Provider Manual

Notice of Personal Provider Status Change

Last Updated on January 24, 2019

The Provider Relations and Contracting Department must be notified of any provider status changes. It is the provider’s responsibility to submit written documentation to the department for notification of any changes. The Request for Change    in Status Form is located here. In the event of extenuating circumstances, a provider may terminate his/her status as a provider. In addition, a provider who had previously terminated his/her status may reactivate this status by requesting the status change in writing.

Status changes include going from an open to a closed practice for new patients or retirement, transfer, leave of absence, resignation, termination at the practice, or any change that prevents the provider from carrying out the responsibilities of a provider.

In the event of a change in status, providers are required to assist Security Health Plan in the transition of member care. It is the responsibility of the contracted practice or provider to inform Medicare Advantage members that care will be transferred to another provider. Medical records and treatment plans must be transferred to the new provider.

Security Health Plan will assist Medicare Advantage members in the transfer of care to an appropriate provider, including specialists, and will notify Medicare Advantage members and other parties of provider status changes as needed.