Medicare AdvantageAdministrativeMedium impact
Provider News - October 2026
Security Health Plan·Chiropractic, General Practice·Provider News
Effective date
Sep 1, 2026
We identified it
Oct 17, 2026
Summary
Security Health Plan published multiple policy updates in October 2026 affecting claims editing, utilization management criteria, medical policies, and pharmacy prior authorization. Key changes include implementation of 2026 InterQual Clinical Criteria (effective Sept. 1, 2026), updates to chiropractic claims editing, and upcoming pharmacy prior authorization changes. The newsletter also contains reminders about Medicare Annual Enrollment Period preparation, Medicaid denial procedures, and provider portal resources.
Action Required
ALREADY EFFECTIVE (September 1, 2026): Billing and clinical teams should verify that the practice has implemented Change Healthcare's 2026 InterQual Clinical Criteria update for utilization management decisions affecting concurrent review, inpatient procedures, urgent inpatient admissions, outpatient procedures, post-acute services, and transitional services. Confirm current applicability with Security Health Plan. CHIROPRACTIC CLAIMS: Billing team should review the updated claims editing process for chiropractic services billed with evaluation and management (E/M) codes and implement changes in the billing system. UPCOMING PHARMACY CHANGES: Billing team should monitor Security Health Plan communications for specific implementation dates and details regarding changes to medical pharmacy prior authorization and post-service claim edits (PSCE) for office-administered, medically billed medications, as the source does not provide a specific effective date. MEDICAL POLICIES: Verify updates to Private Duty Nursing in the Home Setting, Septoplasty, Rhinoplasty, and Sleep Studies (including Type IV testing device definition) have been incorporated into internal medical necessity and documentation requirements. MEDICAID COMPLIANCE: Ensure written procedures describing how Medicaid members are informed of denied services are current, documented, and available to Security Health Plan and DHS upon request. PROVIDER DIRECTORY: Complete and promptly return appointment availability surveys when received, as these are required for NCQA accreditation compliance.