Dear Colleagues,
Here at WPS Health Insurance, we are extremely grateful for health care providers and their staff during this time of change and uncertainty.
We remain committed to communicating important information and updates to you.
In this issue, you can read about:
- Changes to WPS Health Solutions' product names
- The importance of receiving the flu vaccine in light of the COVID-19 public health emergency
- How to make updates to the provider health directory
- How you can use the provider portal to search patient eligibility and benefits
We appreciate the care you give 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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Changes to WPS Health Solutions Product Names
As an in-network provider with WPS Health Insurance, you may be familiar with WPS Health Solutions' wholly owned subsidiary, Arise Health Plan. This fall, we will be changing its name to WPS Health Plan (WPSHP). As new ID cards are issued by Jan. 1, 2021, it is of particular importance to note:
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Does the ID card reference WPS Health Insurance or WPS Health Plan?
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Does your provider Agreement reference WPS Health Insurance or WPS Health Plan, Inc., doing business as Arise Health Plan or WPSHP?
Your provider Agreement is key in determining whether you participate in WPS Health Insurance or WPS Health Plan, formerly known as Arise Health Plan.
The customer ID card will continue to display WPS Health Insurance for customers enrolled in a WPS Health Insurance policy as seen in the example below.
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If you have a contract with Arise Health Plan, you will receive the fall issue of our Arise newsletter with additional information pertaining to the upcoming change.
Your Provider Relations Representative is available to assist if you have questions as to whether you participate with WPS Health Insurance and/or WPS Health Plan. Contact information can be found in the WPS Provider Manual.
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Getting a flu vaccine is more important than ever
As COVID-19 continues to spread throughout Wisconsin, it is more important than ever that our customers get the flu vaccine. With your help, we can achieve better outcomes by being proactive and prescriptive about the flu vaccine. We realize the number of in-person office visits at a clinic or facility are declining, making it more difficult to offer the flu vaccine. We encourage you to discuss the importance of the flu vaccine and where customers are able to obtain it. More information on where customers can get a flu vaccine can be found by visiting vaccinefinder.org.
Contingency plans to lessen the risk of exposure to respiratory germs, like COVID-19, are being developed by the Centers for Disease Control and Prevention (CDC), health care workers, and state and local health departments. According to the CDC, it is likely that both the flu viruses and the virus that causes COVID-19 will be prevalent in the fall and winter months, thus making flu vaccination paramount to reduce the impact of respiratory illnesses in the population. For interim guidance for immunization services during the COVID-19 pandemic, visit cdc.gov/vaccines/pandemic-guidance/index.html.
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Telehealth policy updates
Visit our website for the most up-to-date information regarding our telehealth policy.
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Updating demographics and the provider directory
Current customers, potential customers, and providers use our online provider directory, Find A Doctor, to verify whether a provider participates in our provider networks.
To keep the directory up to date, we count on you, our in-network providers, to notify us of additions, deletions, and changes in a timely manner. This allows us to market your services to our customers appropriately.
We highly recommend that you periodically check our Find A Doctor tool to ensure we have your practitioner names, specialties, and location information listed accurately. If you find an error, please notify us using one of the following methods:
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Practitioner Data Sheet: 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 that sends us a full file for updates, you may continue to do so. However, time-sensitive updates may be emailed to GBNetworkDevelopmentDept@wpsic.com.
Your help in maintaining our directory is very much appreciated by us, our customers, and referring physicians.
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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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If you send them to Eddy, they will be returned to sender.
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Provider portal delivers patient eligibility and benefits |
To better help you care for our customers, our provider portal allows you to search benefits, patient’s network, insurance entity name, patient information, subscriber and policy details, and other insurance information through the Patient Eligibility link—24 hours a day, seven days a week.
To verify patient eligibility, simply click on Patient Eligibility Search and enter the minimum search criteria of:
- Subscriber ID + Date of Birth + Eligibility as of Date; or
- Last Name (partial name accepted) + Date of Birth + Eligibility as of Date; or
- First Name (partial name accepted) + Date of Birth + Eligibility as of Date
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When you press the Search button, matching records are displayed. Click Patient name to see more patient details, including:
- Plan effective and termination dates
- Insurance entity
- Network name
- Copay
- Coinsurance
- Deductible
- Out-of-pocket balances
Information can be exported as a spreadsheet or PDF file by using icons in the upper right corner of your screen.
For complete instructions on how to use the functions of our provider portal, please see the Provider Portal User Guide on our website.
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New policy effective Jan. 1, 2021 (Consultations):
- WPS will no longer allow consultation services with procedure codes 99241–99245 or 99251–99255 for any practice or care provider.
- The appropriate Evaluation and Management (E/M) procedure code that describes the office visit, hospital care, nursing facility care, home service, or domiciliary/rest home care service is reimbursable.
Make sure to also take a look at our updated venipuncture policy.
We also encourage providers to use the Claims Editing System (CES) application available within our provider portal to view or 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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Medical policy updates and review |
The Medical Policy Committee recently met and approved the medical policies due for annual review.
Click here to view 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. 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 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 medical.policies@wpsic.com or call 800-333-5003, ext. 77137.
Policies that will be reviewed in the upcoming months include the following:
October 2020
- Autologous Chondrocyte Implantation (ACI) and Matrix-induced Autologous Chondrocyte Implantation (MACI)
- Gender Dysphoria Treatment
- Osteoarticular Transfer System (OATS) Procedure and Mosaicplasty
- Hip Replacement Surgery
- Knee Replacement Surgery
- Spinal Cord Stimulators
November 2020
- Magnetic Resonance Angiography (MRA)
- Magnetic Resonance Spectroscopy (MRS)
- Nuclear Magnetic Resonance Spectroscopy (NMRS)
- Magnetic Resonance Venography (MRV)
- PET Scan (Positron Emission Tomography)
- Fecal Microbiota Transplant (FMT) Topic
December 2020
- Non-Covered Services Policy
- Telehealth/Telemedicine
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Get paid faster and reduce paperwork with Electronic Funds Transfer and Electronic Remittance Advice |
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Did you know in addition to submitting claims electronically, you can also receive your Provider Remittance Advice and claim payments electronically? We commonly refer to these features as Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT).
The ERA replaces the paper version of the Remittance Advice (RA). WPS delivers 5010 835 versions of all remittance files that are compliant with the Health Insurance Portability and Accountability Act (HIPAA). You can receive your ERA directly from WPS or through your clearinghouse.
When you enroll in EFT, WPS claims payments are deposited directly in the bank account(s) of your choice.
For additional assistance completing ERA and EFT enrollment, please contact the CAQH Enrollment Help Desk toll-free at 844-815-9763.
If you have any additional questions or concerns, please contact us at:
EDI Help Desk Team 800-782-2680 (option 1)
EDI Marketing Team 800-782-2680 (option 2)
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Incomplete appeal forms cause delays |
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If you wish to dispute a claim denied for prior authorization not obtained or denied for services considered not medically necessary or experimental/investigational/unproven, you must submit the dispute in writing via the Provider Appeal Form found on our website.
To ensure your request is reviewed, be sure to complete the form in its entirety. Information we frequently find missing on submitted forms include:
- Claim Specifics:
- Customer Number
- Claim Number
- Date of service
- Contact information for review results:
- Name
- Phone number
- Fax number
- Address
- Additional clinical records to support medical necessity of treatment or device
The Provider Appeal Form must be submitted within 45 days of the date of denial listed on your Provider Remittance Advice (PRA). Because processing provider appeals may take up to 60 days following receipt, we ask that you refrain from status checks until 60 days have passed.
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WPS Health Insurance | 1717 W. Broadway | Madison, WI | wpshealth.com
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©2020 Wisconsin Physicians Service Insurance Corporation. All rights reserved. JO18300 |
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