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Greetings to all,
WPS is very pleased to welcome Dr Peter Goldzweig to our staff, as a full-time Medical Director. Dr Goldzweig is a board-certified anesthesiologist, has served as a member of the Board of Directors, as well as an advisor, for the American Society of Anesthesiologists, and brings to WPS extensive experience in both clinical practice as well as health care management.
We are very excited to have Dr Goldzweig join our team, and are confident that under his guidance, we will continue to simplify operations for you and your staff, while concurrently providing excellent care to our members.
We remain grateful to you for the excellent care provided to your patients and for your commitment to the highest quality of care. If you have any questions or concerns, please contact me at Kevin.Rak@wpsic.com.
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Kevin M. Rak
Medical Director
WPS
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Medical policy updates and review
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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.
The complete library of our medical policies can be found at WPS Medical Policy Updates 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 medical.policies@wpsic.com or 800-333-5003, ext. 06984.
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2025 Formulary Preferred Drug List changes | |
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The updates to the Formulary/Preferred Drug List for 2025 are now available. If you need assistance in determining which formulary applies to the patient, please contact the customer service number listed on the WPS Member ID Card.
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Prescription drug program updates go into effect Jan. 1 | |
Information regarding our Prescription Drug Program can be found on our website. Specifically, you can access:
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Our Prescription 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.
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The Drug Prior Authorization List, which identifies the applicable medications as well as who to contact to initiate the process.
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Formularies/Preferred Drug Lists, which contain the lists of drugs that are covered under the pharmacy benefit including generic drugs, preferred brand-name drugs, specialty drugs, and biosimilars.
If you would like a copy of this information, please contact our Provider Contact Center at 800-765-4977.
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Provider relations new team members | |
The WPS Provider Relations Department is happy to introduce new staff.
Paul Sabin joined our department as Director, Network Development. Paul brings with him over 25 years of managed care experience. He has worked within both the payor and provider sectors, providing him with unique perspective. He has worked for payor entities with various lines of business including commercial, Medicaid, and Medicare. From the provider side, he has worked at a large, Wisconsin based integrated provider system as well as at a specialized DME provider as part of an international company. He can be reached at paul.sabin@wpsic.com or 414-704-1291.
Johnn Etta Smith joined our department as a Contracting Coordinator. Johnn Etta has been with WPS for two years in various capacities. Her strong background in customer service and contract management, both at WPS and elsewhere, is an asset to our department. Johnn Etta is the Provider Relations contact for Northeast region of the state. She can be reached at Johnn.Smith@wpsic.com or 608-977-7077.
For a full list of Provider Relations staff please reference WPS Provider Manual located on our website.
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2025 Provider Manual coming soon | |
The provider manual is designed and produced for you, our preferred providers, to promote a clear understanding of our policies and procedures; including provider services, prior authorization, claims and eligibility. The next update of the WPS Health Insurance manual will be released on our website soon.
In addition to a new look, updates include changes to contact information in Provider Relations and Credentialing, sample ID card and more. To access the manuals, click on Resources > Provider Resources > Support and Education > Provider Manual
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Multifactor authentication (MFA) effective August 16, 2024
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What is Multifactor Authentication (MFA)? MFA is in common use today by many sites. If you log onto a website with your password and are then required to enter a code that is emailed or text-messaged to you, that is MFA.
WPS is committed to securing our customers’ information. Therefore, the WPS EDI
Department has implemented MFA in our WPS Community Manager (WCM) and WPS Gateway Express portals. Users are now required to utilize MFA when they log in. MFA enforcement began for all registered users of these systems on Friday, August 16, 2024.
NOTE: MFA does not apply to SFTP (Secure File Transfer Protocol) connections. If you have questions, please contact our EDI department at 800-782-2680, option 1, then option 6, Monday–Friday, 7:55 a.m.–4:30 p.m. CT.
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WPS Data Logistics: Mail room and accounts payable solutions for hospitals and health systems | |
Delivering unmatched peace of mind, WPS Data Logistics, Inc., headquartered in Madison, Wisconsin, is a subsidiary of WPS, a health solutions company. It offers a variety of business process outsourcing (BPO) solutions including: advanced optical character recognition (OCR), data extraction, electronic data interchange (EDI), mail management, high-volume digital printing, secure destruction, and more.
WPS Data Logistics can support large-capacity customers, using the 32,000-square-foot facility with state-of-the-art security and monitoring. We maximize uptime and productivity thanks to fully redundant systems and 200+ dedicated professionals.
Services offered:
- Full document composition services
- Address standardization and change of address services
- High-volume digital color printing
- Inline dynamic perforation
- Check printing with MICR on-demand
- Automated mail insertion
- Presort and mail logistics
- Postage discounts
- Secure destruction
WPS Data Logistics draws from the experience of WPS, which is a nationally regarded government contractor and a leading Wisconsin not-for-profit health insurer for more than 75 years. We work every day to make health care easier for the people we serve.
If your organization is interested in learning more about how WPS Data Logistics can assist you, please contact us at datalogistics@wpsic.com.
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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.
Need to register for a Provider Portal account? Provider Portal.
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All rights reserved. JO26449
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