Winter 2018
Doctor's note

Dear Colleagues,
In this issue, you'll find a lot of helpful information plus tips to save you time. Please take a few minutes to review this newsletter. 
There are articles on our renamed Arise Premier Network, our provider portal updates, using iExchange for prior authorizations, updates to our 2019 drug formulary, the addition of biosimilars to our coverage, using HEDIS for quality improvement, offset Provider Remittance Advice, and more. My hope is that the information and links contained here will assist you in addressing the needs of your patients who have chosen Arise Health Plan coverage. 
I have a deep appreciation for the work that you do, and we all thank you very much for the great service you provide to our customers. I hope you find the information provided in this newsletter beneficial to your practice.
Best regards,
Dr. Catherine Inman
Arise network change
The Arise AboutHealth Network has a new name. As of Jan. 1, 2019, it will be known as the Arise Premier Network. Customers will continue to have access to the same top-quality providers they've grown accustomed to. It's the same great network, but with a new name. Check out our new Arise Premier Network tip sheet for more information.
Provider portal enhancements  
The new provider portal launched in October. Please take a look at our new Provider Portal User Guide  to answer questions you may have about the new format.
Enhancements to the provider portal include:
  • Ability to view Provider Remittance Advice (PRA) through the portal free of charge
  • Expanded search capabilities that allow you to search for claims by check number
  • Customizable notification feature
  • Ability to export PDF and Excel documents
  • Mobile-friendly view
When you log in to the updated portal for the first time, you will be asked to change your password. Click the Forgot Password link to change your password and establish security questions to activate the account. You will then have access to the redesigned provider portal. If you do not currently have a provider account, please register .
The portal is still under construction, so your online experience will continue to improve. Look to this quarterly newsletter for more information. If you have questions, contact us at 888-915-5477.
Electronic funds transfer express enrollment proces s 

Considering signing up for Electronic Funds Transfers (EFT)? It's easy and secure! We use Multifactor Authentication, an additional form of security to safeguard your information.
If you're not already enrolled in EFT, or if you need to update bank information on your existing account, be prepared with t wo examples of claims paid by Arise within the last 90 days. Each claim must have a positive paid amount and been paid on different check numbers or EFT numbers. Each example should include:
  • Claim number
  • Claim paid amount
  • Claim payment date
  • Check/EFT number of the paid claim

To authenticate your account, you will need to download the Google Authentication Application on your mobile device using either the App Store or Google Play or use the Chrome extension on your browser.


For more information on how to sign up through Arise EFT Express Enrollment, please review the full EFT Enrollment Guide at, contact our WPS EDI Department at 800-782-2680, option 1, or email

iExchange® makes prior authorizations easier

Only 20% of prior authorizations are being submitted electronically to Arise Health Plan via the iExchange program. If you haven't started using iExchange, consider this an invitation to stop using your fax machine and start using iExchange.
Using iExchange speeds up the prior authorization process, allowing your providers to get the answers they need faster than ever before. A speedier process means your patients will receive better care.
iExchange is a web-based portal for providers to submit prior authorization requests to our Integrated Care Management team for review. iExchange is designed to save you time through:
  • Automatic approval of specific requests
  • Easy-to-use upload of supporting documents
  • Elimination of handwriting errors
  • Elimination of fax problems
  • Status tracking of requests
  • Secure environment for protected health information (PHI)
Want to start using iExchange? Here is how to sign up for free: 
  1. Go to
  2. Click on the Providers link
  3. Under Providers, choose the iExchange link
  4. Go to the Register for iExchange page
  5. Fill out the brief form and select Submit 
The Account Administrator will be notified within 10 business days of the approval and will receive the new iExchange Group ID and a temporary password.
Training videos are available on our website on how to register and use iExchange, which can be found here: 
If you have any questions, need assistance with registration, or have technical issues, please contact our iExchange support team at:
Prescription Drug Program updates go into effect Jan. 1

Information regarding our Prescription Drug Program can be found on our website under the  Arise Drug Formulary page. Specifically, you can access:
  • Our Drug Program Policy, which includes how the formulary is developed and maintained, the prior authorization program, how to pursue an exception, and information on generic substitution and quantity limits
  • Formulary/Preferred Drug List
If you would like a copy of this information, please contact our Provider Contact Center at 888-711-1444.
Preferred Drug List Exclusions with Alternatives**
Drug names listed in CAPITALS are BRAND NAME DRUGS. Drug names listed in lowercase are generic drugs.
Drug Class
Excluded Medications
Preferred Alternatives
Antiparkinsonism Agents
pramipexole tablet, pramipexole ER tablet, ropinirole tablet
rasagiline, selegiline
Beta Interferons for Multiple Sclerosis
Blood Glucose Meters & Test Strips
Combination Patches
Corticosteroids (Rectal Formulations)
hydrocortisone enema, UCERIS (FOAM)
Gout Therapy
allopurinol, probenecid
Growth Hormones
Hepatitis C
Hereditary Angioedema
HMG & Cholesterol Inhibitor Combinations
atorvastatin, lovastatin, rosuvastatin, simvastatin, LIVALO
Long-Acting Beta Agonist Nebulized
Long-Acting Opioid Oral Analgesics
hydromorphone ER, morphine sulfate, ER, oxymorphone ER, HYSINGLA ER, NUCYNTA ER, OXYCONTIN
Miscellaneous Topical Dermatological Agents
hydrocortisone, mupirocin
Nonsteroidal Anti-Inflammatory Drugs
fenoprofen calcium (tablet/generic), diclofenac, indomethacin, ibuprofen, meloxicam, nabumetone, naproxen
Ophthalmic Anti-Allergic
azelastine drops, cromolyn drops, olopatadine drops, ALREX, BEPREVE, PAZEO
Ophthalmic Anti-Inflammatory
dexamethasone drops, fluorometholone, drops, prednisolone drops, LOTEMAX
Topical Antiviral Agents
acyclovir (tablet/capsule), famciclovir tablet, valacyclovir tablet, ZOVIRAX CREAM
Topical Corticosteroids
desonide 0.05% (cream/lotion/ointment), desoximetasone 0.25% (cream/ointment)
*May be subject to prior authorization requirements.
**Arise has a pharmacy exception process. Exceptions must be approved in advance for coverage.
Biosimilars added to policies

In our Summer 2018 issue, we shared that biosimilars may be incorporated into our coverage policies once they receive FDA approval and become commercially available. Recall that a biosimilar is a
biological product that is highly similar to and has no clinically meaningful differences from an existing FDA-approved reference product.
The first biosimilars incorporated into our policies were Inflectra® (biosimilar to Remicade®) and Zarxio® (biosimilar to Neupogen®). Recently, other biosimilars have come to market and are also included in our policies (e.g., Fulphila® is a biosimilar to Neulasta® and Retacrit® is a biosimilar to Epogen®/Procrit®).
Providers should expect Arise  to continue to embrace biosimilars as our experience with them grows.
HEDIS used for quality improvement

We annually review and evaluate our Quality Improvement (QI) program and develop a QI work plan that helps us continually improve the quality of care given by our contracted providers. Our QI program and work plan include both clinical and quality service initiatives.

To evaluate program effectiveness, we use the Healthcare Effectiveness Data and Information Set (HEDIS). HEDIS is developed and maintained by the National Committee for Quality Assurance (NCQA), a nonprofit health care quality organization.

Why is HEDIS important to physicians? HEDIS measures track a health plan's and physician's ability to manage health outcomes. Generally, strong HEDIS performance reflects enhanced quality of care. With proactive population management, physicians can monitor care to improve quality while reducing costs.

It's not just about the scores. It's about the woman whose pap smear led to early detection and treatment of her cervical cancer. Or the toddler who didn't get whooping cough because he received the appropriate scheduled immunizations. Or the 65-year-old who kept up with screenings that revealed increased cholesterol. As a result, he received appropriate treatment and potentially avoided another heart attack.

We look forward to working with you, our valued providers, during this upcoming HEDIS season. By working together to meet HEDIS benchmarks, we have the best chance of improving our customers' health outcomes and ultimately their quality of life. If you are interested in pursuing collaborative quality opportunities with us, please contact our Quality Department at
Quarterly medical policy updates
The Medical Policy Committee met this quarter and approved the medical policies due for annual review. The policy updates were emailed to providers in October and we have included them in this issue for your convenience.
Click here  to view the revisions to medical policies.

Note: The mailing sent on Oct. 31, 2018 included an error. Under Prior Authorization Updates and Reminders, the second bullet should read: Cell Free Fetal DNA testing will be denied for non-high-risk, not "no-high-risk pregnancies." The correct version is available through the above link and on
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.
Specific questions or comments regarding development of policy content may be directed to the Medical Policy Editor at or 800-333-5003, ext. 78993. 
Offset Provider Remittance Advice (PRA) 
If you have questions on how to read your PRA as it relates to offset claims, please see our tip sheet, now posted under the Providers section of our website.
Medical policies up for review in March 2019
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. 78993.
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.  
Policies currently undergoing review with practicing providers and scheduled for committee discussion in March include:
  • Acupuncture Therapy
  • Bariatric Surgery
  • Biofeedback Treatments and Devices
  • Blepharoplasty, Blepharoptosis Repair, Brow Lift, and Related Procedures
  • Cell Free Fetal DNA Testing
  • Cranial Orthotic Device
  • Neuropsychological Testing
  • Urine Drug/Alcohol Screening and Testing
  • Chiropractic Services
  • Occipital Nerve Block and Headache Treatments
  • Noncovered Services and Procedures
Coordination of care is crucial among behavioral health and primary care practitioners
Coordination of care among providers is a vital aspect of good treatment planning, ensuring appropriate diagnosis, treatment, and referral.
The importance of communicating with the customer's other health care practitioners cannot be overstated. This includes primary care practitioners (PCPs) and medical specialists, as well as behavioral health practitioners.

Coordination of care is especially important for customers with complex medical care needs and those referred to a behavioral health specialist by another health care practitioner. All practitioners should obtain the appropriate permission from these customers to coordinate care among behavioral health and other
health care practitioners at the time treatment begins.
We expect all health care practitioners to have a mechanism in place to:
  • Discuss with the customer the importance of communicating with other treating practitioners
  • Obtain a signed release from the customer and file a copy in the medical record
  • Document in the medical record if the customer refuses to sign a release
  • Document in the medical record if you request a consultation
  • If you made a referral, transmit necessary information, and if you are furnishing a referral, report appropriate information back to the referring practitioner
  • Document evidence of clinical feedback (i.e., consultation report) that includes, but is not limited to:
    • Diagnosis
    • Treatment plan
    • Referrals
    • Psychopharmacological medication (as applicable)
With this collaborative approach, we can achieve excellent coordination of care and help improve health outcomes.
Arise Health Plan | P.O. Box 11625 | Green Bay, WI |

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