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WPS Health Insurance is pleased to announce the hiring of a new Medical Director, Dr. Jason Kessler. Dr. Kessler is a pediatrician certified by the American Board of Pediatrics (FAAP) and the American Board of Medical Quality. We are excited to add Dr. Kessler to our team and are confident that his contributions will enhance our team and help WPS continue to provide excellent service to our customers and providers. |
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This edition of the newsletter includes important information about:
- Upcoming WPS Health Plan changes
- Provider Manual updates
- WPS Population Health Management programs
- eviCore's provider portal
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Thank you for the care you provide your patients and our customers. If you have any questions, please contact me by email at Kevin.Rak@wpsic.com.
Kevin M. Rak
Medical Director
WPS Health Insurance/WPS Health Plan
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Reminder regarding WPS Health Plan and
customer ID cards
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Effective July 1, 2024, WPS Health Insurance is no longer offering an HMO or POS option through its WPS Health Plan subsidiary*, but is retaining our commercial PPO model.
We are communicating with our WPS Health Plan customers and employer customers to guide them through this streamlining of our product offering. As customers approach their effective date, we will help them enroll in WPS Health Insurance or select a new plan.
WPS Health Plan customers will be provided with new health insurance ID cards as they transition to WPS Health Insurance. Please ensure that your registration staff is aware of this change so they can ask for new ID cards from your WPS Health Plan patients.
If you have any questions, please reach out to your Provider Relations Contract Representative using the contact information in the WPS Provider Manual.
*This includes large group, small group, individual plans, and Administrative Services Only (ASO) products offered to self-funded employees. Medicare supplement insurance plans offered to qualifying individuals are unaffected by this change.
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Mid-year Provider Manual updates | |
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The Provider Manual is considered an extension of your agreement. It is designed and produced to promote a clear understanding of our policies and procedures, including provider services, prior authorizations, claims, and eligibility.
On June 30, 2023, we posted updated Provider Manuals on our website. We encourage you to review the manual(s) in full. Here are a few of the updates.
- Updated the time frames for the concurrent review process from 24 hours to 72 hours
- Added a section to Behavioral Health Care Management regarding Intensive Outpatient Programs (IOP)
- Updated references of Magellan to Evolent Health
- Updated references to telehealth services to virtual care services
Please always refer to the manual posted on the website. This ensures you access the most up-to-date version. To view the updated manual(s), go to wpshealth.com. Under Resources, select Provider Resources > Support and Education > Provider Manual.
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Take advantage of WPS population health management programs | |
WPS Health has three population health management programs. The Multiple Chronic Conditions and Respiratory programs provide customers with education, resources, and assistance such as:
- Helping customers understand the importance of following up with their primary care practitioner or specialists following an emergency room or urgent care visit treating a chronic or respiratory condition.
- Helping customers learn how to better manage their medical conditions by taking their prescribed medications correctly, creating a personalized action plan to discuss with their providers, eliminating or reducing environmental triggers, and incorporating active, healthy lifestyles.
- Providing customers with smoking cessation support and education regarding available community and online resources as well as no-cost smoking cessation products available through their health plan.
- Providing education to customers to ensure they have the supplies and diabetes-related checkups they need to manage their diabetes properly.
The third population health program is for Anxiety and Depression. This program provides customers with resources and assistance such as:
- Helping customers find an in-network mental health provider and telehealth options.
- Providing high-quality integrated health care options.
If you have a patient who you feel would benefit from one of the population health management programs, please call 800-333-5003. Our Population Health Management staff and Registered Nurse Case Managers are eager to help.
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Using the eviCore provider portal for medical and radiation oncology prior authorization requests |
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WPS partners with eviCore Healthcare to manage authorizations for medical oncology and radiation oncology services. Did you know the quickest, most efficient way for you to request a prior authorization is through the eviCore portal?
What are the benefits of using eviCore’s web portal?
Through the web portal, you have 24/7 access to submit and/or check on the status of your request. The portal also offers additional benefits for your convenience:
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Speed: Requests you submit online require half the time (or less) as those you provide over the phone and can often be processed immediately.
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Efficiency: You can attach medical documentation to the case when you submit or when additional information is requested, reducing follow-up calls and consultations.
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Accessibility: If you need to step away, you can save your progress and resume later.
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Real-time access: You can check case status in real time and print determination information.
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Dashboard: You can view all recently submitted cases.
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Duplication feature: If you are submitting more than one prior authorization request, you can duplicate information to expedite submittals.
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eNotification alerts: You can opt in to receive case status email alerts.
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To register for the eviCore provider portal, visit evicore.com. | |
NEW! Zelis Payments for all WPS commercial insurance plans | |
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As of Sept. 1, 2023, WPS expanded its use of Zelis Payments for all WPS commercial insurance plans. This partnership streamlines the automated clearinghouse (ACH) and electronic remittance advice (ERA) delivery processes, allowing for a more simple and seamless experience.
Already enrolled with Zelis Payments:
You are already experiencing the benefits of the program by receiving ACH or virtual card payments and ERA files from Zelis via its portal.
To enroll with Zelis Payments:
Contact a Zelis Provider Enrollment Advisor at 855-496-1571.
Choose not to enroll with Zelis Payments:
If you decide not to enroll with Zelis Payments, you will receive paper checks by mail for all claims. ERA files will be available for download in the WPS provider portal, as well as the Zelis portal.
Check enrollment status:
If you are unsure of your enrollment status, contact a Zelis Provider Enrollment Advisor at 855-774-4395. Representatives are available 7:30 a.m. to 6 p.m. CT, Monday through Thursday and 7:30 a.m. to 4 p.m. CT on Fridays.
Questions:
Should you have any questions regarding the electronic payment change, please email them to Provider.Reimbursement@wpsic.com.
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We have recently archived our Modifier Policy to ensure that we have a separate policy for each pricing modifier. This has created a Split Surgical Procedure Policy, identifying reimbursement for modifiers 54, 55, and 56.
You can see our reimbursement policies on our website under Resources > Support and Education.
We also encourage providers to use the Claim Edit System (CES) application 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 about medical coding related to policies, please contact the Code Governance Committee at codegovernance@wpsic.com.
For questions regarding the policies outside of medical coding, you may contact Provider.Reimbursement@wpsic.com.
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Need to register for the WPS provider portal?
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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 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 Health Insurance/Health Plan 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 call 800-333-5003, ext. 06984.
Policies that will be reviewed in the upcoming months include:
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October 2023 (effective March 1, 2024)
- Negative Pressure Wound Therapy
- Otoplasty and Reconstruction of External Ear
- Varicose Vein Treatments
- Gastrointestinal (GI) Pathogen Testing Using Multiplex Polymerase Chain Reaction (mPCR)
- Fetal Microbiota Transplant
- New-to-Market Medications and New-to-Market Medication List
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November 2023 (effective March 1, 2024)
- 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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Is your practice data and demographic information up to date? | |
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WPS strives to maintain an accurate and comprehensive provider directory. Having accurate data helps our current members, potential members, and providers verify whether a provider participates in our provider networks and is accepting new patients.
It also helps us market your services to our customers appropriately, ensure our customers have uninterrupted access to health care services, and remain compliant with federal guidelines, including the No Surprises Act. To assist in this effort, we ask that you periodically review our online provider directory, Find A Doctor, and notify us of the following in a timely manner.
- Addition/termination of a practitioner, service location, or facility
- Changes to practitioner name, licensure, and/or specialty
- Change in service location or facility name, address, telephone/fax number
- Change in billing information
- Change in tax ID number
- Change in ownership
If you have any additions, terminations and/or changes, please notify us using one of the following methods:
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Practitioner Datasheet: 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 Datasheet: This form allows you to add, terminate, or change information specific to facilities, including clinic physical location updates (opening, closing, relocating, etc.).
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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, you may email time-sensitive updates to GBNetworkDevelopmentDept@wpsic.com.
Your help in ensuring our data is accurate is very much appreciated by us, our customers, and referring physicians.
Email completed Practitioner Datasheet(s) or Facility Datasheet(s) to GBNetworkDevelopmentDept@wpsic.com or
fax to 920-490-6923 Attn: Network Development
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Tips when completing a practitioner or facility datasheet
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Use the most current form on the website to avoid delays in credentialing, contracting, and/or claims payment process. Located under Resources > Provider Resources > Forms and Documents > Provider Directory and Demographic Updates
- Complete all the appropriate sections of the form.
- For the Practitioner Datasheet, be sure to enable CAQH access for WPS Health Insurance/WPS Health Plan when supplying a CAQH number.
- For the Facility Datasheet, make sure to include a copy of the W-9 when adding or updating a facility.
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Holiday closures reminder
Even though our offices will be closed on the following dates, you can still access benefits, patient information, claim status, and other key information via our provider portal.
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CONFIDENTIALITY NOTICE: This e-mail, including any attachments, may contain confidential, privileged and/or proprietary information which is solely for the use of the intended recipient(s). Any review, use, disclosure, or retention by others is strictly prohibited. If you are not an intended recipient, please contact the sender and delete this e-mail, any attachments, and all copies. | |
WPS Health Insurance | 1717 W. Broadway | Madison, WI | wpshealth.com | | |
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©2023 Wisconsin Physicians Service Insurance Corporation and WPS Health Plan,, Inc.
All rights reserved. JO24979
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