Summer 2020
Doctor's Note
Dear Colleagues,
During these uncertain times, we at Arise Health Plan want you to know that we are here for you. We understand that providers’ needs and practices are changing, and though we may not have all the answers, we believe in the importance of dialogue and open communication. Here are a few ways in which Arise Health Plan has responded to the COVID-19 public health emergency:
  • Timely filing limits will not be enforced for claims submitted between April 1, 2020 and Dec. 31, 2020.
  • Timely filing limits for all provider appeals are waived for the remainder of 2020.
  • Providers who have received prior authorizations for procedures and services that have been canceled or postponed will be granted an additional 90 days to perform the procedure or service.
  • We have temporarily expanded our coverage of telehealth services.

Please see the FAQs For Health Care Providers section on our website to keep up to date with the latest changes related to COVID-19.
This issue includes information about how designated Provider Administrators can keep your portal accounts current, along with:

  • How to keep up to date with our telehealth policies and find the current versions of our forms
  • Coordination of care between behavioral health and primary care practitioners
  • How our Case Management program can help your patients

We appreciate the care you give your patients and our customers. If you have any questions, please contact me by email at   or by phone at 608-977-8038.
Jonah Fox, M.D., M.H.A.
Medical Director
Users registered to the same tax ID as your account will be listed under the Account Details section. To narrow the list, you can search using the user’s ID, first or last name, or email address in the Provider User Search section.
Review the Current Status column to verify if the correct users are active or if anyone needs to be deactivated.

To deactivate a user, click the Deactivate button in the Activate/Deactivate Account column. You should receive a pop-up message asking you to confirm you wish to deactivate the user. Click OK to proceed or Cancel to cancel the request. 

To reactivate a user, click the Activate button in the Activate/Deactivate Account column. You should receive a pop-up message asking you to confirm you wish to activate the user. Click OK to proceed or Cancel to cancel the request.
If you have any questions regarding this process, contact Web Support at 888-915-5477 or send a secure message through the portal account. When you contact us, please have your tax ID, the user’s name, registered email address, user ID, the date of two remittance advices, and the total amount paid for each.
 Case Managers can make a difference for your patients
Our RN Case Managers are here to help our mutual customers by:  
  • Coordinating health care among providers
  • Providing education regarding their health care needs and concerns
  • Supporting and advocating for improved health care experiences and outcomes
  • Locating available community resources
  • Understanding their health insurance benefits
  • Assisting them to become better health care consumers
Our RN Case Managers work one-on-one with your patients, treating each person as an individual with unique needs and challenges. Through confidential conversations, they get to know your patients and assist each one to overcome challenges affecting their health management and care.

Recently, one of our RN Case Managers was referred a patient who was overdue on refilling his medications. The 60-year-old man had type 2 diabetes, hypertension, and a history of heart attack. The patient revealed to the case manager that he stopped taking diabetic medications and stopped taking daily blood sugar measurements because his blood sugar levels had been between 100 and 130. Even though the treatment was working, he believed he no longer needed to take the medication as long as his blood sugar was under 200. He made these changes without notifying his physician.

Our Case Manager emphasized the importance of checking with your doctor before undertaking any changes in prescription medication. The Case Manager also explained how even slight continuous elevations of blood glucose can cause damage to small vessels, which can lead to kidney and circulatory damage. The patient was not aware of the danger of these repercussions, especially with his medical history.

The patient called his doctor and was able to schedule an appointment for the very next day. He has resumed taking his medication and measuring his blood sugar daily, with good results.

By providing information and guidance, Case Managers can help flag potential problems and ensure patients are following the prescribed course of treatment, resulting in better outcomes. If you have a patient you feel might benefit from Case Management Services, please contact Medical Management at 800-711-1444 and ask to speak with a Case Manager or email .
Medical policy updates and review
The Medical Policy Committee recently met and approved the medical policies due for annual review.
Please be sure all doctors, other clinical staff, and office staff are aware of these changes before submitting requests for coverage. We ask that you 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  Arise Coverage Policy Bulletins  on our website; no password required.
A technology assessment process is applied to the development of new medical policies and review of existing policies. Policies are reviewed annually, or sooner when there is a significant change reported in the scientific evidence. Published scientific evidence, clinical updates, and professional organization guidelines are reviewed throughout the year, so you can forward a published article at any time.  
We value practitioner input regarding the content of our Medical Policies. If you have published scientific literature you would like to have considered or have questions or comments about policies, please forward them to our Medical Policy editor at  or 800-333-5003, ext. 77137.
Policies that will be reviewed in the upcoming months include the following:

 July 2020
  • Microprocessor Controlled and Myoelectric Limb Prosthesis
  • Shoulder Replacement Surgery
  • Urine Drug/Alcohol Screening and Testing
  • Cell-Free Fetal DNA Testing
  • Pneumatic Compression Devices

August 2020
  • Cochlear Implants, BAHA, Auditory Brainstem Implants, and Other Hearing Assistive Devices
  • Pectus Excavatum, Pectus Carinatum, and Poland Syndrome Treatment
  • Septoplasty and Rhinoplasty
  • Surgical Removal of Redundant Skin and Face/Neck Lift Procedures

September 2020
  • Negative Pressure Wound Therapy (Wound Vac)
  • Otoplasty and Reconstruction of External Ear
  • Varicose Vein Treatment
  • GI Pathogen Testing Using Multiplex Polymerase Chain Reaction (mPCR)
Reimbursement highlights
Check out our Reimbursement Policies included on our website under Providers, Policies, and Reimbursement.

The most recent policies listed:
  • Anesthesia Reimbursement Policy
  • Itemized Bill Review for Inpatient Hospital Claims

Future policy:
  • NCCI Surgical Spine Editing

We also encourage providers to use the Claim Edit System ® (CES) application available within our provider portal to view and edit results and rationale that will be applied to specific code combinations. The CES application is available to all contracted providers through our provider portal . If you do not currently have a provider account, please complete the Request for Provider Access form on our website.

For questions regarding medical coding related to policies, you may contact the Code Governance Committee at .

For questions regarding the policies outside of medical coding, you may contact .
Utilization Management follows timeliness standards
As a health plan accredited by National Committee for Quality Assurance (NCQA), we adhere to the timeliness standards specified by NCQA for review of requested services. The standards include:
  • Non-urgent pre-service decisions are determined within 15 calendar days of receipt of the request
  • Urgent pre-service decisions are determined within 72 hours of receipt of the request
  • Urgent concurrent review decisions are determined within 24 hours of receipt of the request
  • Post-service decisions are determined within 30 calendar days of receipt of the request

These time frames are dependent on the inclusion of necessary clinical information upon receipt of the request. We may request additional medical records if the information submitted to make a determination is not sufficient.

If we cannot make a decision by our standard deadlines, we notify the affected customer and requesting provider that an extension is necessary. The date by which we expect to make a decision is included in that notice.

We consistently strive to exceed these standards and meet the needs of our customers.
Affirmative statement on incentives
Utilization Management (UM) decision-making is based only on appropriateness of care and service and existence of coverage. The organization does not reward practitioners or other individuals for issuing denials of coverage. Financial incentives for UM decision-makers do not encourage decisions that result in underutilization.
Coming soon! Prior authorizations for CPAP rentals available by phone
Arise Health Plan is happy to announce that we will soon be able to process most Continuous Positive Airway Pressure (CPAP) rental prior authorizations over the phone, allowing patients to begin receiving care much more quickly!

Once implemented, you will be able to speak with one of our Intake team members and receive immediate notification if the rental is approved or requires additional review for medical necessity. *

When calling Arise for a CPAP rental prior authorization, please be prepared to provide:
  • Sleep study results, including Apnea-hypopnea Index (AHI)/Respiratory Disturbance Index (RDI)/ Respiratory Event Index (REI)
  • Patient’s diagnoses, including any comorbidities
  • HCPCS codes
  • Ordering physician’s name
  • Date the rental will begin

*Some cases may require additional review by our medical director.
Enroll in Electronic Data Interchange for faster claims payments
COVID-19 continues to affect businesses across the world, including Wisconsin. Arise is doing our part to reduce the spread of the virus by following social distancing guidelines and recommendations. Our Electronic Data Interchange (EDI) teams are dedicated to reducing the impact of COVID-19 on processing claims for our community providers. One example is by alleviating potential processing and payment delays for non-electronic claim submissions.

If you have not already enrolled in the option to submit your claims electronically, you are encouraged to do so by visiting   Arise Health Plan .  Filing electronically will help speed up your claims processing.

Arise Health Plan also partners with the nationally recognized Committee for Affordable Quality Healthcare (CAQH) EnrollHub ® solution and combines enrollment capabilities for electronic funds transfer (EFT) and electronic remittance advice (ERA). Not only is this faster, but it is at no charge to your practice!
Arise Health Plan |  P .O. Box 11625 | Green Bay, WI |
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