Doctor's Note
Dear Colleagues,
Recently, full federal approval was granted for the Pfizer-BioNTech coronavirus vaccine for people 16 and older. It remains to be seen if and how FDA approval will impact vaccination rates and mandates across the country. The approval comes at a time when infections, hospitalizations, and deaths have increased markedly, largely due to the Delta variant. At present, hospitalizations and deaths are higher in states with the lowest vaccination rates, and per the Centers for Disease Control and Prevention, the overwhelming majority of the U.S. population lives in an area with high COVID-19 transmission. At WPS, we continue to encourage everyone eligible to get vaccinated to do so.
In this issue, we have included updates regarding:
- Our Opioid Population Health Program
- Reimbursement highlights
- Provider portal administration
Thank you for the care you provide to your patients and our customers. If you have any questions, please contact me by email at Jonah.Fox@wpsic.com or by phone at 608-977-8038.
Sincerely,
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Jonah Fox, M.D., M.H.A.
Medical Director
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WPS, Auxiant offering new ASO product |
WPS is teaming up with Auxiant to develop a new Administrative Services Only (ASO) product to serve self-funded employers. This new product will be available Jan. 1, 2022, and will allow us to better serve ASO members. We are working to minimize operational changes and are developing guidance for providers. In the meantime, if you have specific questions you would like us to address, please email us at ProviderASOQuestions@wpsic.com.
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Urge your patients to get the flu shot: we've got them covered!
WPS Health Insurance covers all preventive immunizations at 100%, including the influenza vaccination. If an office visit is associated with the vaccination and that office visit is billed using a primary diagnosis showing immunization or vaccination, then that office visit is considered preventive and is covered at 100% in-network.
Additionally, WPS Health Insurance also covers all preventive immunizations administered at an in-network pharmacy at 100%, including the administration charge typically billed in conjunction with the charge for the vaccination itself.
We encourage you to discuss the importance of the flu vaccine with your patients, along with where they can get it. By being proactive, we can more effectively fight the flu.
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WPS Opioid Population Health Program helps personalize care
According to the Centers for Disease Control and Prevention, prescription opioids are often prescribed following surgery or injury to treat moderate to severe pain. In recent years, opioids have been prescribed more frequently for the treatment of chronic non-malignant pain, despite serious risks and lack of evidence about their long-term effectiveness.
Opioid prescription drugs used to treat pain include oxycodone, hydrocodone, codeine, morphine, and others. While prescription opioids are generally safe when taken for a short time as prescribed by a doctor, they can be misused by taking them in a different way or in a larger dose than prescribed. Regular use can lead to dependence, overdose incidents, and death.
WPS Health Insurance has Population Health Specialists and Registered Nurse Case Managers who work together to coordinate programs for our customers' care.
A nurse will contact patients in the program to help them:
- Understand the instructions on properly following the prescription
- Answer any questions they may have
- Connect patients with community-based resources, if necessary
If you have a patient who wants to participate in the Population Health Management Program, please call 800-333-5003.
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Easily find the forms and documents you need |
A host of valuable forms and documents are available on our website, including the following:
- Corrected Claim Form
- Claims Reconsideration Form
- HIPAA Forms and Documents
- iExchange (electronic prior authorization tool)
- Outpatient Behavioral Healthcare Treatment Plans Request Forms
- Prior Authorization Guidelines
- Prior Authorization Request Forms
- Provider Appeal Form
- Provider Directory and Demographic Update Forms (Practitioner and Facility Data Sheets)
- Utilization Management/Quality Management Program and Procedures
Be sure that you are using the most up-to-date version of our forms. Using an outdated form may cause delays in the credentialing, contracting, and/or claims payment processes.
If you are unable to find what you are looking for, contact our Provider Customer Service Center at 800-765-4977.
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How to update your provider demographic information |
WPS Health Insurance strives to maintain an accurate, comprehensive provider directory, and to remain compliant with federal guidelines. To assist in this effort, we ask that providers notify us of demographic updates as soon as possible. These include, but are not limited to:
- 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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You can notify WPS Health Insurance of provider updates using one of the following methods:
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Practitioner Data Sheet: This form allows you to add a new practitioner to your group, forward changes related to a practitioner’s demographic information or practice location, or notify us of a practitioner’s termination from your group.
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Facility Data Sheet: This form allows you to add, terminate, or change information specific to facilities, including clinic physical location updates (opening, closing, relocating, etc.). If you are unsure whether the facility form is appropriate in your situation, please see the facility types listed to the right.
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Full File: If you are currently a health system provider who sends us a full file for updates, you may continue to do so. However, time-sensitive updates may be emailed to GBNetworkDevelopmentDept@wpsic.com.
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Facility Types
- Clinic locations
- Clinical laboratories
- Comprehensive outpatient rehabilitation facilities (CORFs)
- Dialysis centers
- Freestanding ambulatory surgery centers
- Home health agencies (including home infusion)
- Hospices
- Hospitals
- Inpatient/residential/ambulatory behavioral health (BH) facilities (this does not include BH clinics)
- Portable X-ray suppliers
- Rural health clinics (RHCs) and Federally Qualified Health Centers (FQHCs)
- Skilled nursing facilities
- Urgent care facilities
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Triamcinolone acetonide extended-release (Zilretta®) gets C rating for treating knee osteoarthritis
Hayes, one of our evidence-based resources, recently updated its assessment of triamcinolone acetonide extended-release (Zilretta) for the management of knee osteoarthritis. Per the Hayes Health Technology Assessment released July 13, 2021, Zilretta remains at a C rating.
This rating reflects a low-quality body of evidence suggesting that Zilretta may safely relieve pain and improve function in patients with knee osteoarthritis. However, the additional benefit of treatment with Zilretta relative to corticosteroid injection (standard of care) has yet to be clearly demonstrated. Substantial uncertainty remains due to inconsistencies in outcomes across studies. Few studies clearly demonstrate efficacy compared with the placebo. Thus, Zilretta will continue to be on our Non-Covered Services and Procedures Policy.
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Medical Policy updates and review |
The Medical Policy Committee recently met and approved the medical policies due for annual review. View the revised medical policies.
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.
A technology assessment process is applied to the development of new medical policies and review of existing policies. Policies are reviewed annually or 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 medical.policies@wpsic.com or call 800-333-5003, ext. 06984.
Policies that will be reviewed in the upcoming months include the following:
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October 2021
Effective March 1, 2022
- Negative Pressure Wound Therapy
- Otoplasty and Reconstruction of External Ear
- Varicose Vein Treatments
- Gastrointestinal (GI) Pathogen Testing Using Multiplex Polymerase Chain Reaction (mPCR)
- Fecal Microbiota Transplant
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November 2021
Effective March 1, 2022
- Autologous Chondrocyte Implantation (ACI) and Matrix-induced Autologous Chondrocyte Implantation (MACI)
- Gender Dysphoria Treatment
- Osteoarticular Transfer System (OATS) Procedure and Mosaicplasty
- Spinal Cord Stimulators
- Hip Replacement Surgery
- Knee Replacement Surgery
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December 2021
Effective June 1, 2022
- Magnetic Resonance Angiography (MRA), (MRV)
- Magnetic Resonance Spectoscopy (MRS), (NMRS)
- PET Scan (Positron Emission Tomography)
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View the latest reimbursement highlights |
Check out our Reimbursement Policies on our website under Resources, Provider Resources, Support and Education.
Recently reviewed reimbursement policies:
- Anesthesia Reimbursement Policy
- Increased Procedural Services Policy
- Modifier Reimbursement: Modifier 63 (clarification)
We also encourage providers to use the Claims Editing System (CES) application available within our provider portal to view 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 a Request for Provider Access on our website.
For questions regarding medical coding related to policies, you may contact the Code Governance Committee at codegovernance@wpsic.com.
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Provider portal administrator: adding and maintaining user access |
Provider administrators are responsible for maintaining user access accounts. This includes submitting invitations for user access and regularly reviewing user access to ensure that employees who have terminated or who should no longer have access to the portal are deactivated.
Invitations for user access
Provider administrators can invite additional users who need access to the provider portal. Users have the same access as the administrator except for creating and maintaining accounts. To generate an invitation, access the Provider Invitation section under Profile Management. Enter the user type, first name, last name, email, and institution name and indicate your understanding. Please note: users will only be active for the Tax ID associated with the provider administrator. To finalize the request, click the Generate Invitation Email button.
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Once the invitation is sent, end users will receive an invitation email. Invitations sent from provider administrators do not need approval before accessing the portal. Invitations sent from WPS will need approval, which can be completed by accessing the Provider Signup Queue under Profile Management.
Maintaining user access
To view a list of your registered users, select Profile Management followed by Provider Account Management from the dashboard of your portal account.
Review the status column to verify if the correct users are active or if any staff members need to be deactivated. You can search using the user’s ID, first or last name, or email address.
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 your 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 your wish to activate the user. Click OK to proceed or Cancel to cancel the request.
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If you have any questions regarding this process, contact Web Support at 888-915-5477, Monday through Friday, 7:30 a.m. to 5 p.m. 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, and the date of two remittance advices and the total amount paid for each.
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Need to register for the provider portal? |
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Holiday closures reminder |
WPS Health Insurance will be closed in observance of the following holidays:
Veterans Day
Thursday, Nov. 11
Thanksgiving
Thursday, Nov. 25
Day after Thanksgiving
Friday, Nov. 26
Christmas Eve
Friday, Dec. 24
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WPS Health Insurance | 1717 W. Broadway | Madison, WI | wpshealth.com
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©2021 Wisconsin Physicians Service Insurance Corporation. All rights reserved. JO21203 |
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