Security Health Plan to manage musculoskeletal and therapy prior authorizations for members in Security Administrative Services plans
Effective Jan. 1, 2020, Security Health Plan will manage musculoskeletal procedure and outpatient therapy prior authorizations (PA) for members enrolled in the following Security Administrative Services (SAS) plans, regardless of the rendering provider: Marshfield Clinic Health System employer group, Marshfield Medical Center-Beaver Dam, Abbyland Foods, City of Stevens Point, Marathon Bank, Mid-State Technical College and Simplicity Credit Union. All other SAS plans will continue to be managed by their specific utilization management vendor (e.g. Hines) for these services.
SAS members in the groups noted above will require PA from Security Health Plan for:
- musculoskeletal - joint surgery, spine surgery
- therapies - occupational therapy, physical therapy, speech therapy
Updated PA requirements through Security Health Plan for other treatments and procedures will be implemented later in 2020 for SAS plan members, including:
- pain management
- cardiac procedures
- sleep study program
Providers will be notified when an active effective date is established for these PA requirements.
Security Health Plan will follow our regular process of PA requirements through our vendors for all other prior authorizations.
For all SAS groups, please review each member ID card to find the utilization management vendor (e.g. Hines) and prior authorization requirements. It is the rendering provider’s responsibility to ensure PA requirements are met before a member’s scheduled appointment. If PA requirements are not met, claims could be denied.
In addition, Security Health Plan requires precertification for any inpatient services noted above.
Click here to see the full list of PA requirements.