Provider News - August 2024

REQUIREMENTS: - Immediately: Billing and clinical staff must transition ALL prior authorization requests to electronic submission through Security Health Plan's provider portal. Discontinue faxing or calling in PA requests. Providers will receive faster turnaround time through electronic submission. - Immediately: Verify ProAuth/TruCare system has been upgraded to version 10.1.1.0.0 and train staff on new functionality to view TruCare-generated letters through ProAuth tool. - Before next formulary update: Pharmacy and billing teams must review Security Health Plan's updated formulary for Humira biosimilar coverage across large/small group, ASO, and marketplace plans. Verify which biosimilars are covered and update prior authorization requirements and billing processes accordingly. - Ongoing: Revenue cycle and clinical staff must ensure complete and accurate HCC coding documentation for all patient acute and chronic conditions to optimize risk adjustment scores. Review recent HCC coding updates from Security Health Plan. - For critical access hospitals, swing beds, and rural health clinics: Submit most recent CMS rate letters to Security Health Plan immediately. Security Health Plan cannot access these independently and reimbursement is based on current rate letters. - By next monthly update (approximately September 5, 2024): Verify practice information in Security Health Plan online provider directory is current. Contact Provider Relations at 715-221-9640, fax 715-221-9699, or email shpprd@securityhealth.org to report any changes to practice location, name, ownership, provider status, or patient acceptance. - Consequences of non-compliance: Prior auth requests submitted via fax/phone will experience delays; inaccurate HCC coding will negatively impact risk adjustment scores; outdated directory information will hinder patient ability to locate providers.