In This Issue
The Doctor's Note
June 2015

Dear Clinicians,


I am very pleased to introduce myself as the new WPS Medical Director for Network and Quality. I am a Family Physician and spent many years in full time practice, including Obstetrics. My administrative experience spans the last two decades with long forays into quality, case management, provider relations, and contracting.


My goal is to have WPS provide value to you and to make our relationship one that is enriching, sustainable, and mutually beneficial. Good communication forms the bedrock for making this a reality. These newsletters are created to help you and your staff have the information and resources to work together with us.


We would appreciate feedback when you see the need for process improvements. Finally, feel free to call or email me with questions.


Kind regards,


Michael Ostrov MD MS

Medical Director Network and Quality

WPS Health Insurance


ICD-10 Readiness

WPS Electronic Data Services is continuing to prepare and test the Electronic Data Interchange (EDI) receipt of ICD-10 standards in the 837 transactions. If you are interested in testing with us, you can submit acceptance-only test files for ICD-10 validation testing during the first week of Aug. 2015.


Our testing process


Since the first ICD-10 announcement, we have been thoroughly testing and converting our systems through the entire claims process. We want to ensure a smooth transition to the ICD-10 coding implementation for all of our providers.


How you can test with us


This summer, we'll be testing acceptance-only files from our providers for ICD-10 validation. This testing confirms that your submitted claims will be accepted by our systems. Our next acceptance testing window will be from Aug. 3-7, 2015.


To test in our current environment, we've set the testing date parameters so you can submit past claims with dates of service beginning April 1, 2014, to a present date of service. This way you can utilize current data as ICD-10 testing samples.


How to submit live claims for ICD-10


To ensure accurate and timely claims processing, please submit claims with dates of service prior to Oct. 1, 2015 using ICD-9 coding. All claims for dates of service Oct. 1, 2015 and after should use ICD-10 coding. WPS will return all claims for proper coding that do not follow the mandated coding rules, without exception.


Questions? Contact the EDI Help Desk at 1-800-782-2680.


Additional ICD-10 coding transition for provider resources:

ANSI Codes Now Available on the
WPS Provider Portal

Based on your feedback, enhancements have been added to our

Provider Portal. When researching claim status through your account, ANSI code information will now be displayed. This added self-help tool will allow you to determine how your claim adjudicated in a quick and timely manner.


If you have not registered to access the Provider Portal, simply send an email to with the following information: administrator name, email address, tax ID, practice name, phone number, and a list of all clinic locations (including addresses).


Check out all the benefits and features of using the Provider Portal today!  

Electronic Tools Available To You
Want to save time, money, and paper by filing electronic claims?

Complete our Electric Data Interchange (EDI) Claims Agreement form at:


Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT) are also available. There is no paperwork involved! Fill out our online forms, submit them, and you'll be on your way to savings.


These online forms can be found at: for ERAs and for EFTs.


Any questions, please contact our EDI department:

  • Help Desk: 1-800-782-2680 (press #2)
  • Hours: 7 a.m.-5 p.m. Mon-Thurs; 8 a.m.-4:30 p.m. Fri (CST)
  • Marketing: 1-800-782-2680 (press #4)
  • Fax: 1-608-223-3824
  • Email: 
  • Via the web: EDI 

Thank you for choosing WPS as your trusted insurance partner!

Unlisted Procedure Code Reminder
Before using an unlisted or not otherwise classified (NOC) code,

please be sure there is not a more specific code that could be used to describe the procedure or service being provided.


When there is not a specific code available, providers are required to submit the supporting documentation and description of the procedure/service rendered or requested. Submitting proper documentation will result in timelier processing of claims and prior authorizations. If supporting documentation is not received, the code in question will be denied until required information supporting the unlisted procedure is submitted and reviewed.


Questions? Please call 1-888-711-1444, ext. 76344.

Medical Policy Updates

The Medical Policy Committee met this quarter and approved the medical policies due for annual review.  


Click here to review 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.


The complete library of our medical policies can be found at:  

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. 

Observation Stay Review Change

Observation care has traditionally bridged the gap between outpatient and inpatient care. Most often, observation care is completed in less than 24 hours.  


Effective July 1, 2015 WPS will begin to review observation level of care. It is the policy of WPS that services be administered in the least costly manner and in a location that is safe and appropriate for the patient.


Inpatient admission or transition to inpatient admission from observation care is generally indicated when a condition, such as an acute Mycardial Infraction (MI), is diagnosed requiring a longer-term stay or when longer-term treatment or monitoring is needed for a condition. MCG (formerly Milliman Care Guidelines) will be the primary reference when determining medical necessity.

iExchange Enhancements
iExchange is a web-based tool program offered by WPS Health

Insurance that allows your clinical staff to electronically and securely submit prior authorization requests. It best serves our customers by offering quick turnaround times on those requests.


We have added an attachment feature to iExchange that will allow you to simply attach requested clinical information from the patients file.You no longer have to cut and paste clinical information into your iExchange request. The system accepts the following file types:

  • Word (.doc and .docx)
  • Excel (.xls and .xlsx)
  • JPEG (.jpg)
  • Adobe (.pdf)

Instructions for adding attachments can be found here:


In an effort to improve automation, we have on-going reviews of our clinical business rules. This allows us to update codes that may be eligible for auto approval. The auto approval process involves the interactive portion of the prior authorization request. If the service being requested meets our clinical business rules, we are able to send an instant approval notice with no manual review.


Messaging features have been updated to notify the requesting provider instantly should a service not require prior authorization.


Please include your name and contact information when submitting a request so we can contact you as soon as possible if we have a question or need additional information.


We are happy to visit your office to provide iExchange training. If you are interested, please contact Jim Sarnosky at 608-226-4159 or


WPS is always looking for ways to improve our services to you. Please email your ideas to to share your suggestions on how to enhance the iExchange experience.


Wisconsin Physicians Service?