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The Doctor's Note
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June 2015
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|  Dear Clinicians, I am very pleased to introduce myself as the new Arise Medical Director for Network and Quality. I am a Family Physician and spent many years in full-time practice, including Obstetrics. My administrative experience spans the last two decades with long forays into quality, case management, provider relations, and contracting. My goal is to have Arise provide value to you and to make our relationship one that is enriching, sustainable, and mutually beneficial. Good communication forms the bedrock for making this a reality. These newsletters are created to help you and your staff have the information and resources to work together with us. We would appreciate feedback when you see the need for process improvements. Finally, feel free to call or email me with questions. Kind regards, 
Michael Ostrov MD MS Medical Director Network and Quality WPS Health Insurance 608-221-5076 [email protected] |
ICD-10 Readiness
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| Arise is continuing to prepare and test the Electronic Data Interchange (EDI) receipt of ICD-10 standards in the 837 transactions. If you are interested in testing with us, you can submit acceptance-only test files for ICD-10 validation testing during the first week of Aug. 2015. Our testing process Since the first ICD-10 announcement, we have been thoroughly testing and converting our systems through the entire claims process. We want to ensure a smooth transition to the ICD-10 coding implementation for all of our providers. How you can test with us This summer, we'll be testing acceptance-only files from our providers for ICD-10 validation. This testing confirms that your submitted claims will be accepted by our systems. Our next acceptance testing window will be from Aug. 3-7, 2015. To test in our current environment, we've set the testing date parameters so you can submit past claims with dates of service beginning April 1, 2014, to a present date of service. This way you can utilize current data as ICD-10 testing samples. How to submit live claims for ICD-10 To ensure accurate and timely claims processing, please submit claims with dates of service prior to Oct. 1, 2015 using ICD-9 coding. All claims for dates of service Oct. 1, 2015 and after should use ICD-10 coding. Arise will return all claims for proper coding that do not follow the mandated coding rules, without exception.
Questions? Contact the EDI Help Desk at 1-800-782-2680.
Additional ICD-10 coding transition for provider resources:
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EDI Claim Submissions Change
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| Effective May 1, 2015, all Arise Electronic Data Interchange (EDI) claim submissions are no longer routed through ClaimsNet. Electronic claims must be routed to Arise via WPS EDI for processing, regardless of the date of service. Electronic claims may be submitted to Arise using our secure File Transfer Protocol (FTP) process (WPS Secure EDI used to transfer files from one host to another) or the WPS Bulletin Board System (BBS). If you are currently submitting directly to a clearinghouse, please note, they have been notified of this change. If you have any questions about the submission of EDI claims to Arise, our EDI help desk will be able to assist you with additional information regarding your claim submission options. You can email us at [email protected]. You may also contact our EDI help desk at 1-800-782-2680, option 2 for additional assistance. We encourage new providers to check out our EDI website at https://www.wpsic.com/edi/tools.shtml for more information. |
Electronic Tools Available to You
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| Want to save time, money, and paper by filing electronic claims? Complete our Electric Data Interchange (EDI) Claims Agreement form at https://www.wpsic.com/edi/files/edi-claims-agreement.pdf Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT) are also available. There is no paperwork involved! Fill out the online forms, submit them, and you'll be on your way to savings. These online forms can be found at https://corp-ws.wpsic.com/apps/wtps-web/unauth/eraEnrollLoadAction.do for ERAs and https://corp-ws.wpsic.com/apps/wtps-web/unauth/eftEnrollLoadAction.do for EFTs. Any questions, please contact our EDI department:
- Help Desk: 1-800-782-2680 (press #2)
- Hours: 7 a.m.-5 p.m. Mon-Thurs; 8 a.m.-4:30 p.m. Fri (CST)
- Marketing: 1-800-782-2680 (press #4)
- Fax: 1-608-223-3824
- Email: [email protected]
- Via the web: EDI
Thank you for choosing Arise as your trusted insurance partner! |
Unlisted Procedure Code Reminder
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| Before using an unlisted or not otherwise classified (NOC) code, please be sure there is not a more specific code that could be used to describe the procedure or service being provided. When there is not a specific code available, providers are required to submit the supporting documentation and description of the procedure/service rendered or requested. Submitting proper documentation will result in timelier processing of claims and prior authorizations. If supporting documentation is not received, the code in question will be denied until required information supporting the unlisted procedure is submitted and reviewed. Questions? Please call 1-888-711-1444, ext. 76344.
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Medical Policy Updates
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| The Medical Policy Committee met this quarter and approved the medical policies due for annual review. Click here to review the revisions to medical policies. Please be sure all doctors, other clinical staff, and office staff are aware of these changes before submitting requests for coverage. Please also share these policy changes with providers who may be ordering or performing services and clinicians who may be referring patients for services. The complete library of our medical policies can be found at
If you have specific questions or comments regarding development of policy content, contact the Medical Policy Editor by email [email protected] or call 1-800-333-5003 ext. 64133.
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Observation Stay Review Change
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| Observation care has traditionally bridged the gap between outpatient and inpatient care. Most often, observation care is completed in less than 24 hours. Effective July 1, 2015, Arise will begin to review observation level of care. It is the policy of Arise that services be administered in the least costly manner and in a location that is safe and appropriate for the patient. Inpatient admission or transition to inpatient admission from observation care is generally indicated when a condition, such as an acute Mycardial Infartion (MI), is diagnosed requiring a longer-term stay or when longer-term treatment or monitoring is needed for a condition. MCG (formerly Milliman Care Guidelines) will be the primary reference when determining medical necessity. |
Availability of Medical Policy Guidelines
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Physicians and other practitioners may obtain the medical policy guidelines used for making medical coverage determinations for an Arise Health Plan member under their care. If you have received a determination and would like to review the medical policy guidelines used in that decision, you may contact us. To obtain medical policy guidelines for a specific subject through the Medical Management Department of Arise Health Plan, submit your request by phone, fax, or in writing. Arise Health Plan Medical Management Dept. P.O. Box 11625 Green Bay, WI 54307-1625 920-490-6900 ? 888-711-1444 Fax: 920-490-6943 Please include the subject (procedure/service/treatment) for the particular medical policy in question, along with the patient name and member number when applicable. The policy guidelines are an informational resource, not an authorization, an explanation of benefits, or a contract to provide benefits. Receipt of benefits is subject to satisfaction of all terms and conditions of the member's contract in effect at the time services are rendered. Medical technology is constantly changing and we reserve the right to review and update our medical policy guidelines as necessary. We hope that by providing the specific medical policy guidelines upon request, you may better understand the basis for a decision. Our policy guidelines are based on sound medical and clinical evidence and adopted with the involvement of appropriate medical specialists. If you have questions or suggestions, please send them in writing to the Arise Health Plan Medical Management Department at the address above.
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Authorization Denial Notices
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Arise physicians and other practitioners may contact a physician,
appropriate behavioral health specialist, or a pharmacist reviewer to discuss medical necessity denial decisions for an Arise Health Plan member under their care. If you have received a denial notice for which you would like to review medical policy guidelines and discuss determination rationale, you may contact the Arise Health Plan Management Department by phone, fax, or in writing. Arise Health Plan Medical Management Dept. P.O. Box 11625 Green Bay, WI 54307-1625 920-490-6900 ? 888-711-1444 Fax: 920-490-6943 |
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