Medicare AdvantageAdministrativeHigh impact
Provider News - March 2025
Security Health Plan·Provider News
Effective date
May 1, 2025
We identified it
Jun 20, 2026
Summary
Security Health Plan updated provider appeal timeframes for Medicare Advantage products, reducing the appeal deadline from 365 days to 60 days starting May 1, 2025. Commercial formulary changes take effect April 1, 2025, and providers must use the secure portal for all prior authorization requests.
Action Required
By May 1, 2025: Update billing team procedures to ensure all Medicare Advantage claim appeals are submitted within 60 days of the provider statement showing denial or partial payment. Train staff on new appeal timeframe and update tracking systems. Claims processed after 5/1/2025 follow the 60-day rule; claims before that date remain at 365 days. Immediately: Ensure all prior authorization requests are submitted through Security Health Plan's secure provider portal only.