For efficient filing of commonly used forms, providers may print the following Security Health Plan forms directly from this website, fill them out and fax them to Security Health Plan. These forms are also available by contacting Security Health Plan's Provider Relations or Health Services departments.
To complete the Credentialing application please email firstname.lastname@example.org. Please include the following items (provider name, National Provider Identifier (NPI), date of Birth, email address, phone number, facility name, facility address with street address, city, state and zip code. If you have any questions please feel free to call 1-800-548-1224.
837/835 Enrollment Request
837 (Institutional) Companion Guide
837 (Professional) Companion Guide
837 (Dental) Companion Guide
Claim Payment/Advice - 835 Companion Guide
Roster Billing Form - CMS 1500
Roster Billing Form - UB
Claims Status Inquiry
EFT Reference guide
EFT Enrollment form
EFT Change/Cancellation form
Provider Appeal Process