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Provider Manual

Pre-certification of Hospital Admissions

Last Updated on August 28, 2018

The provider, not the member, is responsible to precertify an admission to the hospital for medical and/ or surgical treatment.

Based on medical diagnosis or proposed surgery and medical information, Security Health Plan will:

  • Authorize coverage for a length of stay based on InterQual Level of Care Guidelines, Truven LOS Guidelines. (Remember that these are a minimum length of stay consistent with quality care. Actual length of coverage for a stay is based on medical necessity and intensity of service)
  • Upon request, send a copy of the appropriate guidelines (available by contacting the Security Health Plan utilization management specialist).

Contact the Security Health Plan utilization review coordinator at 1-800-991-8109 (option #1 or #2) or 715-221-9768 or 715-221-9661.