Medicare AdvantageAdministrativeHigh impact
Provider News - May 2025
Security Health Plan·Provider News
Effective date
May 1, 2025
We identified it
Jun 20, 2026
Summary
Security Health Plan's May 2025 provider newsletter includes several key updates: Medicare Advantage appeal timeframe reduced from 365 to 65 days effective May 1, 2025; Humira and Stelara will be removed from formulary July 1, 2025 requiring switch to biosimilars; and new 2025 InterQual criteria now in use for medical necessity reviews.
Action Required
By May 1, 2025: Update billing team procedures to ensure all Medicare Advantage appeals are submitted within 65 days of provider statement (reduced from 365 days). Before July 1, 2025: Notify providers that Humira and Stelara will no longer be covered for Commercial and Marketplace patients - coordinate with providers to transition patients to preferred biosimilars. Immediately: Review medical necessity documentation to align with new 2025 InterQual criteria for concurrent reviews, inpatient/outpatient procedures, and post-acute services.