 |
|
Doctor's Note
This issue contains a number of articles to help you and your team stay informed about the many approaches we are taking to improve our collaboration with you. A few examples are:
1) Detailed medical policy updates
2) Tips for using our Provider Portal
3) Communication of changes in viscosupplementation injection coverage (for example, knee injections)
As always, it is our goal to provide you with the resources and support you need to care for your patients who are also our members. We aim to make your work with us intuitive and seamless.
If you have
any questions, you can contact me at 608-977-8981 or
[email protected].
Best of health,
Michael Ostrov, M.D., M.S.
Vice President and Chief Medical Officer
|
|
Postpartum depression screening is encouraged
According to the American College of Obstetricians and Gynecologists (ACOG), perinatal depression is one of the most common medical complications associated with pregnancy. The organization recommends women be screened at least one time for depression within the perinatal period.¹
This year, we will be looking at the percentage of our members who were screened for depression at their postpartum visits. We will be encouraging members to ask their practitioners about postpartum depression screening via our member newsletter. Included below are some recognized tools used for depression screening:
If a patient scores positive for depression, please consult with a behavioral health practitioner.
|
|
Diabetes screening data being reviewed to encourage coordination of care between medical, behavioral providers
HEDIS (Healthcare Effectiveness Data and Information Set) has several measures of performance on specific dimensions of care and service. One of these measures looks at the percentage of members--ages 18-64, with schizophrenia or bipolar disorder, who are taking an antipsychotic medication--to identify if they were screened for diabetes within the calendar year. Even though this measure is specific to the Medicaid population, we will be reviewing data for certain product lines to encourage continuity and coordination of care between medical care and behavioral health care.
|
|
Viscosupplementation injection now considered unproven
Effective July 1, 2017, all forms and brands of hyaluronan and derivatives used as viscosupplements will be considered
unproven, and therefore not covered, to affect health outcomes in the treatment of osteoarthritis and other related joint conditions.
The accumulated scientific evidence has failed to support the efficacy of the treatment or improved outcomes for osteoarthritis.
Years ago, viscosupplementation was proposed for the treatment of osteoarthritis of the knee, showing promise in delaying the need for-or even presenting an alternative to-total knee replacement. It became a common treatment. However, in recent years,
the scientific evidence no longer supports this treatment.
On May 18, 2013, the American Academy of Orthopaedic Surgeons (AAOS) published the Treatment of Osteoarthritis of the Knee Evidence-Based Guideline 2nd Edition, which included a Strong Level Recommendation against
using hyaluronic acid for patients with symptomatic osteoarthritis of the knee.
View the statement online.
The evidence for continued use of hyaluronan viscosupplementation became a subject of controversy. Results of additional research and analyses continued to be published.
By February 2017, MCG, one of our primary evidence-based resources, changed its previous clinical indications to "Current Role Remains Uncertain." New evidence that resulted in this change included several analyses published in 2015 and 2016, which concluded that there was little or no improvement in pain and function for patients with knee osteoarthritis treated with intra-articular hyaluronic acid, and there remained uncertainties about the clinical benefit of this treatment; further high-quality studies were recommended. Mention of the AAOS recommendation against viscosupplementation was also made.
In view of this recommendation and numerous other evidence-based sources, our Medical Policy Committee now considers hyaluronan viscosupplementation unproven to affect outcomes in the treatment of osteoarthritis and other related conditions for all joints; therefore, it is not covered.
Questions and comments can be sent to the Medical Policy Committee at
[email protected]
. For questions regarding medical coding related to Medical Policies, please contact the Code Governance Committee at
[email protected].
|
|
Quarterly Medical Policy Updates
The Medical Policy Committee met this quarter and approved the medical policies due for annual review.
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.
Specific questions or comments regarding development of policy content may be directed to the Medical Policy Editor at
[email protected]
or 800-333-5003 ext. 77196.
|
|
Affirmative statement on incentives
Utilization Management (UM) decision-making is based only on appropriateness of care and service and existence of coverage. The organization does not specifically reward practitioners or other individuals for issuing denials of coverage. Financial incentives for UM decision-makers do not encourage decisions that result in underutilization.
|
|
Enroll today for Electronic Funds Transfer
Improve efficiency and go green with our Electronic Funds Transfer (EFT) direct deposit service. When you use EFT, you no longer have to wait for paper checks to be delivered through the mail. Instead, your payment is deposited right into your checking or savings account. This environmentally responsible electronic process uses less paper.
Your Electronic Remittance Advice will be your office's notification of the payment that will be posted to your account. Notification of your payment into your account will come from your bank. Please contact your bank for their notification procedures.
|
|
Provider Portal tips: One sign-on for three insurance entities plus where to find network information
If you are currently using our Provider Portal, you are aware that your one account will provide information for WPS Health Insurance, Arise Health Plan, and Aspirus Arise members. As shown in the picture below, the Portal now clearly identifies which insurance entity applies to the member or claim in question.
Note: Not all providers are contracted with all three insurance entities. Your current Agreement specifies the insurance entity that pertains to your office/facility.
Where to find provider network for a member
The Patient Inquiry Screens, as seen below, now reflect the provider network(s) that are tied to a member's plan under the
Find a Patient Search Results page and
Patient Information Detail page.
Be sure to check the effective dates of the member's policy, as the provider network will remain on the screen even if the plan has terminated. Should a member change networks with no lapse in coverage, two rows will be reflected; one for the current network and one indicating the previous network with applicable dates. "No Network Found" will be indicated for policies that do not have networks, such as a dental plan.
|
WPS Health Insurance | 1717 W. Broadway | Madison, WI |
wpsic.com
27885-021-1706
|
|
See what's happening on our social sites:
|
|
|
|
|
|
|
|
|
