CommercialAdministrativeMedium impact
Provider News - April 2026
Security Health Plan·Provider News
Effective date
May 1, 2026
We identified it
Jun 20, 2026
Summary
Security Health Plan will reinstate Excludes1 note claim editing logic for all claims processed on or after May 1, 2026, affecting facility and professional claims across all product lines. The policy also provides updates on provider portal enhancements, contact changes, and various administrative reminders including proper Medicaid billing requirements.
Action Required
By May 1, 2026: Billing team must ensure all claims comply with ICD-10 Excludes1 note editing logic. Review current claim edits and update billing system to account for stricter Excludes1 validation. Train staff on proper diagnosis code sequencing to avoid claim denials. Monitor claims closely after implementation date for any rejections related to Excludes1 conflicts.