Medicare AdvantageCoverageHigh impact
Provider News - March 2017
Security Health Plan·WI · Cardiothoracic Surgery, Vascular Surgery, Gastroenterology +7 more·Provider News
Effective date
Feb 1, 2017
We identified it
Jul 15, 2026
Summary
Security Health Plan has released multiple new medical policies and updated existing ones effective January-February 2017, including 10 newly developed policies (Cryoablation, Gastric Pacing, Urinary Incontinence, Migraine/Cluster Headache management, and others) and updated criteria for existing procedures. Providers must obtain copies of these policies to ensure billing compliance, as payment requires meeting all outlined medical criteria. Prior authorization requirements for commercial plans remain in effect for office and outpatient-based procedures.
Action Required
By March 31, 2017: Billing team and clinical providers must request and review copies of all 10 newly developed policies from Security Health Plan effective 2/1/17 (Medtronic IN.PACT Admiral Paclitaxel-coated PTA Balloon, Cryoablation, Gastric Pacing and Gastric Electrical Stimulation, Ivor Lewis Procedure, Implantable Hormone Pellet Replacement Therapy, Urinary Incontinence, Migraine and Cluster Headache Nonsurgical Management) and policies effective 1/1/17 (Hyperbaric Oxygen Therapy, Tilt Table Testing, Core Decompression for AVN). For all procedures in your office, download the updated policies from www.securityhealth.org for the 13 existing policies with new medical criteria (Back Surgical Procedures, Vertebroplasty, Breast Reconstruction, Maze, Abdominoplasty, Panniculectomy, Botulinum Toxin Injections, Infuse Bone Graft, Lipectomy, Wearable Hearing Aids, and others). Update your billing system and clinical documentation templates to reflect new medical necessity criteria. Immediately verify that all P2, P3, and R2 indicator office and outpatient procedures have prior authorization obtained before billing on commercial plans. Contact Provider Assistance Line at 1-800-548-1224 or visit www.securityhealth.org/priorauthorizations to confirm prior authorization requirements. Failure to meet policy medical criteria or obtain required prior authorization will result in claim denials.