Dear Colleagues and Office Staff,
I hope your practices are flourishing in this new year and that the conversion to ICD-10 has not been an undue burden. I want to let you know that more than ever, our goal is to improve the collaboration we, as a health plan, have with you on the front lines of care for the people in your practice.
We are looking to do this in new ways that go beyond the utilization management that you have become so used to. This includes developing reports that you will find useful for practice outreach and case management by your staff for select people with higher-level needs. Eventually, we want to provide you with information that is useful to you in real time. We are exploring ideas along these lines. The articles in this newsletter highlight programs and procedures that we developed or improved upon that are aimed at improving our communication of essential information with one another.
In addition, we are working to develop outreach programs that make use of community agencies and chronic care specialists to actually go out into people's homes. The goals are to help people under active treatment coordinate their care better, organize their personal support systems and optimize use of community resources. We are also contemplating starting a program of health literacy and patient engagement classes for people with more complex needs. These kinds of classes have been successful in other settings, such as Medicare. I would like to expand them to select people covered under commercial insurance.
As always, feel free to contact me with any questions.
Michael Ostrov, M.D., M.S.
Revised User Guides
Updates to Provider Portal add access for Arise Health Plan providers
While using the WPS Provider Portal, you may have noticed a new look. There has been no change in the functionality of the Provider Portal. However, Arise Health Plan (Arise) providers now have access to Arise member and claim information in the portal. Arise is an NCQA-accredited health plan based in DePere and a wholly owned subsidiary of WPS Health Insurance. If you do business with WPS and Arise, you can now use the same portal for both.
If you'd like to register for the Provider Portal so you can take advantage of real-time access to member eligibility and benefits, our Claim Center, Provider Directory, and secured messaging, it's simple.
end an email to
with the following information: Administrator name, email address, tax ID, practice name, and a list of all clinic locations (including addresses).
Practitioner Data Sheet
Process for roster changes updated under new credentialing process
If you currently use our
Practitioner Data Sheet
Facility Data Sheet
to notify us of roster changes, you may have noticed some changes to the forms. The changes are the result of WPS partnering with Arise Health Plan in our credentialing process. Arise Health Plan, an NCQA-accredited health plan based in DePere, is a wholly owned subsidiary of WPS Health Insurance.
Recent revisions to the forms include an updated return email address and fax number, as well as the addition of the Arise Health Plan logo.
Please remember that you can use the Data Sheets for the following:
- Add a practitioner to your roster
- Remove a practitioner from your roster
- Change a practitioner name
- Add specialty
- Add location
- Close location
Our Provider Home page at
includes the Data Sheets, as well as many other helpful forms for your use.
EDI website modifications improve navigation
We recently revised our Electronic Data Services (EDI) website for easier navigation. The new site allows you to search by each of WPS Health Solutions' lines of business:
- Arise Health Plan
- Veterans Affair Patient-Centered Community Care
- WPS Health Insurance
Other enhancements include:
- Centralized location of all online EDI enrollment forms.
- Updated version of our "Five Easy Steps to Electronic Claim Filing."
- Rolling message board for improved awareness of current events and updates.
- Easy access to EDI Connection, which is a list of our current approved clearinghouses, billing services, and vendors.
- EDI Glossary of Definitions
- A list of "Receiver and Payer ID" codes by line of business
Check out all of the changes at
. If you have questions, please contact the EDI department at 800-782-2680 or email
Medicare Rx Coverage
Important Medicare prescription drug update
Effective June 1, 2016, the Centers for Medicare & Medicaid Services (CMS) will no longer accept prescriptions for Medicare beneficiaries from providers who are not enrolled with Medicare. This affects all providers including dentists, physicians, psychiatrists, residents, nurse practitioners and physician assistants who have patients in a Part D plan or Medicare Advantage plan. Any delay in enrolling in this program could result in Medicare patients being unable to obtain drugs you prescribe.
Unless you are enrolled in Medicare (or validly opt out),
Medicare Part D plans will be required to notify Medicare patients that your prescriptions will not be eligible for coverage. If you should opt out, you will be unable to receive reimbursement from traditional Medicare or a Medicare Advantage plan, except for emergency and urgent care services.
There are no fees to enroll in the program and it can be completed electronically, or on paper. Based on your preference, please visit the following websites:
- Paper: The paper application can be found at go.cms.gov/cms855o. Please submit the completed paperwork to the appropriate Medicare Administrative Contractor (MAC). To locate your MAC for your area, please refer to go.cms.gov/partdmaclist.
Questions related to this upcoming change should be directed to the MAC within your geographic area.
Quarterly Medical Policy Updates
The Medical Policy Committee met this quarter 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. Please also share these policy changes with providers who may be ordering or performing services and clinicians who may be referring patients for services.
No password required!
If you have specific questions or comments regarding development of policy content, contact the Medical Policy Editor by email
or call 1-800-333-5003 ext. 64133.
WPS Health Insurance| 1717 W. Broadway | Madison, WI |
See what's happening on our social sites: