CommercialPrior AuthMedium impact
Provider News - June 2018
Security Health Plan·WI · Oncology, Endocrinology·Provider News
Effective date
Oct 1, 2018
We identified it
Jun 20, 2026
Summary
Security Health Plan provider newsletter covering care management success story, upcoming RADV audit requirements, maternity notification policy changes, new prior authorization requirements for specialty drugs effective October 1, 2018, and EHR documentation compliance guidance.
Action Required
By October 1, 2018: Billing team must update prior authorization procedures for 10 specialty drugs including Aldurazyme, Cerezyme, Elaprase, Elelyso, Lumizyme, Naglazyme, Vpriv, Bavencio, Cuvitru, Sustol, and Tecentriq through Magellan Rx. Update billing software to flag these medications for prior auth. Review EHR documentation practices to avoid cloning and ensure compliance with CMS guidelines. Prepare medical records department for potential RADV audit requests.