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Medical Policy updates and review | Please note these changes and their effective dates. | |
At their most recent meeting, the Medical Policy Committee approved several new medical policies and completed scheduled annual policy reviews. Please take a few moments to review these updates and their effective dates to determine how they apply to your practice.
Medical Policy updates
Please be sure all doctors, other clinical staff and office staff are aware of these changes before submitting requests for coverage for services and issuing referrals.
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A library of our medical policies can be viewed online at WPS Medical Policy.
Specific questions or comments regarding development of policy content may be directed to the Medical Policy Editor at medical.policies@wpsic.com.
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Payment integrity enhancements | |
We would like to inform you of upcoming enhancements to our claims processing protocols, expected to be implemented on July 1, 2026.
As part of our ongoing efforts to ensure accuracy, consistency and alignment with industry standards, we are planning to introduce the following claim editing enhancements:
- Expanded prepayment claim editing aligned with nationally recognized coding and billing guidelines
- Diagnosis-Related Group (DRG) validation
- ICD-10-CM Excludes1 Edits
Edits may include, but are not limited to, review of modifier requirements, diagnosis-to-procedure consistency, and alignment with coding guidelines.
These updates are intended to support accurate claims processing and promote appropriate coding and billing practices.
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Helping patients find you faster:
WPS and BetterDoctor Partnership. | New partnership will enhance accuracy and simplify provider verification. | |
WPS is pleased to announce a new partnership with Quest Analytics' BetterDoctor to support provider directory accuracy and streamline the verification process for our contracted providers.
Maintaining accurate directory information is essential for:
- Helping members efficiently find and access care.
- Enhancing the overall patient experience.
Key Details:
- Starting in April, BetterDoctor will contact our contracted providers every 90 days via fax, email, mail or phone to verify and update directory details (practice locations, contact info and availability).
- Providers will need to review their information, confirm accuracy or submit updates as needed.
- Updates and attestations submitted via BetterDoctor may also be shared with other participating health plans, reducing the number of verification requests providers receive and lowering administrative burden.
Important Reminder:
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To add/remove practitioners or locations, please complete the Practitioner Data Sheet or Facility Data Sheet, which is separate from the BetterDoctor outreach and still required for contracting and credentialing purposes.
We value our partnership with providers and appreciate your continued efforts in keeping directory information accurate.
For questions related to Quest Analytics BetterDoctor, please contact
providernetworksolutions@wpsic.com for assistance.
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Keep us informed about changes so we can share them with our customers—your patients. | |
The WPS Provider Directory is more than a reference guide for our customers. It also helps us market your services and ensures our customers have uninterrupted access to health care services. Please use the appropriate forms to notify us if you have:
- Practitioners joining or leaving your organization
- Changes to practitioner name, licensure or specialty
- Change in billing or other contact information
- Change in service location
- Acquisition of other medical practice or entity
- Change in tax ID number or legal business name
- Change in ownership
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Not sure which form to use?
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Practitioner Data Sheet:
- Add a new practitioner to your group
- Change a practitioner’s demographic information
- Change a practitioner’s location
- Notify us of a practitioner’s termination from your group
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Facility Data Sheet:
- Add, terminate or change information specific to facilities
- Submit clinic physical location updates including opening, closing or relocating
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Go to our website to find the most up-to-date version of these forms.
Email completed forms to GBNetworkDevelopmentDept@wpsic.com or fax to 920-490-6923, Attn: Network Development.
Note regarding full files: If you currently send us a full file for updates, you may continue to do so. However, if you have a time-sensitive update, please email it to GBNetworkDevelopmentDept@wpsic.com.
Important reminder: Health care providers must update their National Plan and Provider Enumeration System (NPPES) data within 30 days of any change to required information, per 45 CFR 162.410(a)(4).
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Arise payer ID discontinued | Take action now to maintain claim submission access. | |
WPS Health Solutions’ Arise Health Plan was decommissioned on Dec. 31, 2024. The “ARISE” payer ID remained active throughout 2025 to support claim submissions for services rendered in 2024.
Effective Jan. 3, 2026, the “ARISE” payer ID was discontinued. Going forward, all transactions for WPS Health Plan—including Large Group, ASO and Family Care—must be submitted using the “WPS” payer ID. If you previously used the “ARISE” payer ID and haven’t already done so, please complete a new EDI Agreement through WPS EDI Express Enrollment (E3) at https://www.wpshealth.com/resources/provider-resources/edi/enrollment.shtml.
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Get the information you need from WPS customer ID cards | Make sure registration staff makes a copy of the card for your files. | |
WPS customer ID cards contain important health insurance data, including contact details, ID numbers, plan types and copay information. Having a copy of your patient’s WPS customer ID card will help you:
- Confirm patient identity and details.
- Identify current copays and deductibles.
- Streamline claims and obtain necessary authorizations.
- Keep COB information current to prevent claim denials.
| Questions?
Please call the phone number on the customer’s ID card. |
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Get your Provider Remittance Advice online | Use our portal for quick and easy access to PRAs and other helpful tools. | |
Want to reduce delays in obtaining your Provider Remittance Advice (PRAs)? Our online portal offers a faster, more efficient way for you to access PRAs and manage key information in real time.
You can also use the portal to check claim status, verify eligibility and network participation, review copayments and deductibles, and use the Code Combination Simulation Tool. The portal offers convenient, 24/7 access to essential tools and information, saving you time and improving overall efficiency for your facility.
Important reminder: We do not accept documentation through secure messages on the portal. Here are some common examples of documentation and their submission procedures. The forms mentioned can be found on the Forms and Documents page of the Provider section of our website.
- EOBs—Please submit a claim form with the EOB to the claims address.
- Medical records—Please use a WPS claims reconsideration form and submit it with the medical records to the claims address or fax number listed on the form.
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Prior authorization request—WPS offers a FREE online service for providers to speed up prior authorization requests called iExchange. This online portal allows you to electronically submit prior authorization requests for inpatient and outpatient services directly to WPS 24 hours a day, 7 days a week.
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Help us welcome our new Provider Relations associates | Brandi Parcel and Haley Oelke are looking forward to working with you. | |
Brandi Parcel joins WPS as our new Director of Network Management.
She brings more than 17 years of experience in healthcare payer‑side operations, along with a strong record of leadership and collaboration.
Her background in strategic negotiations, value‑based contracting and cultivating meaningful provider partnerships positions her well to support our continued growth. Brandi’s ability to balance provider collaboration with operational efficiency reflects WPS’ commitment to innovation and service excellence.
She looks forward to strengthening the trusted relationships WPS has built with our provider community. We are confident that her leadership will help advance and expand our network, supporting our shared goal of delivering high‑quality, accessible care to the members we serve.
Haley Oelke joins WPS as our new Provider Contract Manager. Haley comes to us with nearly 15 years of experience in the health insurance industry with a focus on provider contracting and network development. She values building strong, collaborative relationships and takes pride in thoughtful, ongoing relationship management that supports access, quality care and long-term partnerships. Haley looks forward to connecting with providers and serving as a trusted, approachable resource.
We are thrilled to have Brandi and Haley on board to help advance our network.
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Upcoming holiday schedule
While our offices will be closed on the following dates, providers will still have access to benefits, patient information, claim status and other key information via the Provider Portal.
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