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 and 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.  

Updated Clinical Practice Guidelines and recommendations, along with a note from Dr. Phil Colmenares, our chief Medical Officer, are on our website . Please take a moment to read the message and try out the links to the updated Clinical Practice Guidelines. We hope you find them useful resources.   

What you should know about the Arise Provider Portal

The Arise Health Plan Provider Portal is your resource for quick, convenient access to member and claim information. The portal is designed to provide real-time access in the following areas:

The Patient Inquiry function provides information on benefits, eligibility, deductible limits, coinsurance, copays, and more.

The Claim Center allows you to search by member number and rendering provider to find claim information. You can check to see if and how a claim was processed. You can also submit an electronic claim to Arise.

 

The Claims Editing System (CES) allows providers to proactively determine how a particular code combination will process. Providers are able to enter procedure codes, modifiers, diagnosis codes, dates of service, patient genders, dates of birth, and places of service parameters in order to review results specific to the procedure codes being queried. The results and rationale will be displayed and can be downloaded as a PDF. This allows greater transparency of the code combination edits being used at Arise Health Plan.

The Find A Doctor feature enables you to locate an in-network provider. 

The  Message Center  allows you to send and receive secure emails to and from Arise .

To register for an account, send an email to [email protected] with the following information:  administrator name, email address, tax ID, and practice name. 

If you already have an account for WPS Health Insurance, you can use the same account for both WPS and Arise.

• Arise Health Plan
• Medicare
• TRICARE
• Veterans Affairs Patient-Centered Community Care
• WPS Health Insurance 

• 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