Security_health_plan_of_wisconsin_inc Prior Authorization Lookup
- Security_health_plan_of_wisconsin_inc coverage criteria
- All Security_health_plan_of_wisconsin_inc policy updates
Latest Security_health_plan_of_wisconsin_inc prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Skin and Tissue SubstitutesThis policy governs coverage, medical necessity, limitations, exclusions, and prior authorization requirements for bioengineered skin and soft-tissue substitutes and skin substitute grafts. Requirements vary by product, indication, and line of business, including Commercial, Medicaid, Family Health Center, Medicare Advantage, and third-party administration arrangements.All security_health_plan_of_wisconsin_inc updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Yartemlea (narsoplimab-wuug) for transplant-associated thrombotic microangiopathyThis policy governs prior authorization, dosing, renewal, and billing requirements for intravenous Yartemlea (narsoplimab-wuug) used to treat transplant-associated thrombotic microangiopathy after hematopoietic stem cell transplantation for eligible Security Health Plan members.All security_health_plan_of_wisconsin_inc updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-01Lipectomy or Suction-Assisted LipectomyThis policy governs coverage, medical necessity, prior authorization, limitations, and exclusions for lipectomy and suction-assisted lipectomy across applicable Health Plan products. Coverage may apply when specific clinical criteria are met, including treatment of lipedema or breast reconstruction.All security_health_plan_of_wisconsin_inc updates
- Prior AuthClinical/Medical PolicyEff. 2026-05-01Behavioral Health/Substance Use Disorder (SUD) TreatmentThis policy governs coverage, utilization management, prior authorization, notification, and program-specific limitations for mental health and substance use disorder services across Security Health Plan commercial, Medicaid, Family Health Center, Medicare Advantage, and third-party administration products.All security_health_plan_of_wisconsin_inc updates
- Prior AuthClinical/Medical PolicyEff. 2026-05-01Septoplasty/RhinoplastyThis policy governs coverage, medical-necessity review, prior authorization, and exclusions for nasal surgery, including septoplasty, rhinoplasty, septal dermatoplasty, rhinophyma procedures, and surgical repair of vestibular stenosis. Requirements vary by commercial, BadgerCare Plus/Medicaid SSI, Medicare Advantage, Family Health Center, and third-party administration products.All security_health_plan_of_wisconsin_inc updates
- Prior AuthClinical/Medical PolicyEff. 2026-04-01Long Term Acute Care (LTAC) FacilityThis policy governs medical-necessity review, precertification, and coverage of long-term acute care facility admissions and continued stays for applicable Health Plan products, including Commercial, Medicaid, Medicare Advantage, Family Health Center, and TPA products.All security_health_plan_of_wisconsin_inc updates
- Prior AuthClinical/Medical PolicyEff. 2026-02-01Back Surgical Procedures: Cervical and Thoracic Spinal Levels - Inpatient and Outpatient SettingsThis policy governs coverage, medical-necessity review, precertification, and exclusions for cervical and thoracic back surgical procedures in inpatient and outpatient settings. Requirements vary by product, including Commercial, Medicaid, Medicare Advantage, TPA, and Family Health Center products.All security_health_plan_of_wisconsin_inc updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Ambulance: Land and Air TransportationThis policy governs coverage, prior authorization, destination requirements, and administrative handling for emergency and non-emergency land ambulance, air/helicopter, and hospital-to-hospital transportation across applicable Health Plan products.All security_health_plan_of_wisconsin_inc updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Genetic Testing Oncology: Hereditary CancerCoverage, medical-necessity review, and prior-authorization requirements for genetic testing used to evaluate hereditary cancer susceptibility across Commercial, Medicaid/BadgerCare Plus, Family Health Center, Medicare Advantage, and third-party administration products.All security_health_plan_of_wisconsin_inc updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Genetic Testing: CardiovascularThis policy governs coverage, medical-necessity review, and prior-authorization requirements for genetic, genomic, and molecular testing used to diagnose or manage inherited and sporadic cardiovascular conditions across Commercial, Wisconsin Medicaid/BadgerCare Plus, Medicare Advantage, Third Party Administration, and Family Health Center products.All security_health_plan_of_wisconsin_inc updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Genetic Testing: NephrologyThis policy governs coverage, medical necessity, and prior authorization requirements for genetic, genomic, and molecular testing used to evaluate known or suspected kidney disorders, including testing of asymptomatic potential living donors. Requirements vary by product, including Commercial, Medicaid/BadgerCare Plus, Family Health Center, Medicare Advantage, and Third Party Administration plans.All security_health_plan_of_wisconsin_inc updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Genetic Testing: Nutrition and MetabolismThis policy governs coverage and utilization management for genetic, genomic, and molecular testing related to nutrition, metabolic, endocrine, and mitochondrial conditions across specified Health Plan products. Coverage, prior authorization, and medical-necessity requirements vary by product, including Commercial, Medicaid, Medicare Advantage, Family Health Center, and Third Party Administration plans.All security_health_plan_of_wisconsin_inc updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Genetic Testing: RespiratoryThis policy governs coverage, medical-necessity review, and prior-authorization requirements for diagnostic genetic and molecular tests for lung and other respiratory disorders across specified Health Plan product lines in Wisconsin.All security_health_plan_of_wisconsin_inc updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Imaavy (nipocalimab-aahu) (Intravenous)This policy governs prior authorization, medical necessity, dosing, renewal, and billing requirements for intravenous Imaavy used for generalized myasthenia gravis or another FDA-labeled indication. It applies to providers requesting coverage through Security Health Plan of Wisconsin.All security_health_plan_of_wisconsin_inc updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Varicose Vein TreatmentsThis policy governs coverage, medical-necessity review, limitations, exclusions, and site-of-service requirements for varicose vein treatments across Security Health Plan commercial, Medicaid, Family Health Center, Medicare Advantage, and third-party administrator products. Prior authorization is generally not required, but applicable clinical criteria must be met when the claim is submitted.All security_health_plan_of_wisconsin_inc updates
- Prior AuthClinical/Medical PolicyAdzynma (recombinant ADAMTS13) for Congenital Thrombotic Thrombocytopenic PurpuraPrior authorization, dosing, coverage criteria, renewal, and billing for intravenous Adzynma in members with severe hereditary ADAMTS13 deficiency and congenital thrombotic thrombocytopenic purpura, including prophylactic and on-demand therapy.All security_health_plan_of_wisconsin_inc updates
- Prior AuthClinical/Medical PolicyDecitabine (Dacogen; Decitabine) Prior Authorization CriteriaPrior authorization, dosing limits, initial approval, renewal, administration, billing, and covered diagnoses for intravenous decitabine in adults with selected myeloid malignancies.All security_health_plan_of_wisconsin_inc updates
- Prior AuthClinical/Medical PolicyGivlaari (givosiran) Coverage for Acute Hepatic PorphyriaThis policy governs prior authorization, dosing, renewal, and billing requirements for subcutaneous Givlaari (givosiran) used to treat acute hepatic porphyria. It applies to providers submitting requests for covered members, including initial and renewal authorizations.All security_health_plan_of_wisconsin_inc updates
- Prior AuthClinical/Medical PolicyHaegarda (C1 Esterase Inhibitor Subcutaneous [Human]) for Hereditary Angioedema ProphylaxisThis policy governs prior authorization, dosing, coverage criteria, renewal, administration, and billing for Haegarda used to prevent hereditary angioedema attacks in patients seeking coverage under Security Health Plan of Wisconsin, Inc.All security_health_plan_of_wisconsin_inc updates
- Prior AuthClinical/Medical PolicyHemgenix (etranacogene dezaparvovec-drlb) for Hemophilia BThis policy governs prior authorization, medical necessity, dosing, administration, and billing for Hemgenix intravenous gene therapy in adults with moderately severe or severe congenital factor IX deficiency. Authorization is limited to one dose and cannot be renewed.All security_health_plan_of_wisconsin_inc updates
- Prior AuthClinical/Medical PolicyKisunla (donanemab-azbt) Intravenous Therapy for Early Alzheimer's DiseaseThis policy governs prior authorization, dosing, renewal, administration, and billing requirements for intravenous Kisunla in adults with mild cognitive impairment due to Alzheimer's disease or mild Alzheimer's dementia. It applies to providers requesting or administering treatment under Security Health Plan of Wisconsin.All security_health_plan_of_wisconsin_inc updates
- Prior AuthClinical/Medical PolicyLeqvio (inclisiran) Subcutaneous InjectionThis policy governs prior authorization, medical necessity, dosing, renewal, and billing requirements for Leqvio (inclisiran) used to lower LDL-C in members with hypercholesterolemia, heterozygous familial hypercholesterolemia, or homozygous familial hypercholesterolemia.All security_health_plan_of_wisconsin_inc updates
- Prior AuthClinical/Medical PolicyLuxturna (voretigene neparvovec-rzyl) Subretinal InjectionThis policy governs prior authorization, dosing limits, coverage criteria, administration, and billing requirements for Luxturna in patients with biallelic RPE65 mutation-associated retinal dystrophy in Wisconsin.All security_health_plan_of_wisconsin_inc updates
- Prior AuthClinical/Medical PolicyMepsevii (vestronidase alfa-vjbk) for MPS VIIThis policy governs prior authorization, initial approval, renewal, dosing, administration, and billing requirements for intravenous Mepsevii used to treat mucopolysaccharidosis VII (MPS VII, Sly syndrome). It applies to members seeking coverage for this specialty enzyme replacement therapy.All security_health_plan_of_wisconsin_inc updates
- Prior AuthClinical/Medical PolicyNucala (mepolizumab) Subcutaneous TherapyThis policy governs prior authorization, initial approval, renewal, dosing, and concomitant-use requirements for subcutaneous Nucala in severe eosinophilic asthma, COPD, EGPA, HES, CRSwNP, and other FDA-labeled or compendia-supported indications for Security Health Plan members.All security_health_plan_of_wisconsin_inc updates
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Tool Description
Search Security_health_plan_of_wisconsin_incprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
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