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Doctor's Note
Dear Colleagues,
In this issue, you'll find a lot of helpful information plus tips to save you time. Please take a few minutes to review this newsletter.
There are articles on our provider portal updates, electronic funds transfer express enrollment process, the advantages of our iExchange prior authorization process, updates to our 2019 drug formulary, using HEDIS for quality improvement, quarterly medical policy updates, and more. My hope is that the information and links contained here will assist you in addressing the needs of your patients who have chosen Aspirus Arise coverage.
I have a deep appreciation for the work that you do, and we all thank you very much for the great service you provide to our members. I hope you find the information provided in this newsletter beneficial to your practice.
Best Regards,
Dr. Catherine Inman
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Provider Portal Enhancements
We're excited to announce the new provider portal launched in October. Please take a look at our new
Provider Portal User Guide
to answer questions you may have about the new format.
Enhancements to the provider portal include:
- Ability to view Provider Remittance Advice (PRA) through the portal free of charge
- Expanded search capabilities that allow you to search for claims by check number
- Customizable notification feature
- Ability to export PDF and Excel documents
- Mobile-friendly view
When you log in to the updated portal for the first time, you will be asked to change your password. Click the Forgot Password link to change your password and establish security questions to activate the account. You will then have access to the redesigned provider portal. If you do not currently have a provider account, please
register
.
The portal is still under construction, so your online experience will continue to improve. Look to this quarterly newsletter for more information. If you have questions, contact us at 888-915-5477.
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Electronic Funds Transfer Express Enrollment Process
Considering signing up for Electronic Funds Transfers (EFT)? It's easy and secure! We use Multifactor Authentication, an additional form of security to safeguard your information.
If you're not already enrolled in EFT, or if you need to update bank information on your existing account, be prepared with two examples of claims paid by Aspirus Arise within the last 90 days. Each claim must have a positive paid amount and been paid on different check numbers or EFT numbers. Each claim example must include:
- Claim number
- Claim paid amount
- Claim payment date
- Check/EFT number of the paid claim
To authenticate your account, you will need to download the Google Authentication Application on your mobile device, using either the App Store or Google Play, or use the Chrome extension on your browser.
For more information on how to sign up through WPS EFT Express Enrollment, please review the full EFT Enrollment Guide at
wpshealth.com
, contact our WPS EDI Department at 800-782-2680, option 1, or email
edi@wpsic.com
.
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iExchange Makes Prior Authorizations Easier
Only 20% of prior authorizations are being submitted electronically to Aspirus Arise via the iExchange program. If you haven't started using iExchange, consider this an invitation to stop using your fax machine and start using iExchange.
Using iExchange speeds up the prior authorization process, allowing your providers to get the answers they need faster than ever before. A speedier process means your patients will receive better care.
iExchange is a web-based portal for providers to submit prior authorization requests to our Integrated Care Management team for review. iExchange is designed to save you time through:
- Automatic approval of specific requests
- Easy-to-use upload of supporting documents
- Elimination of handwriting errors
- Elimination of fax problems
- Status tracking of requests
- Secure environment for protected health information (PHI)
Want to start using iExchange? Here is how to sign up for free:
- Go to AspirusArise.com
- Click on the Providers link
- Click the iExchange button
- Open the Register for an Account section
- Fill out the brief form and select Submit
The Account Administrator will be notified within 10 business days of the approval and will receive the new iExchange Group ID and a temporary password.
Training videos are available on our website under Training Tutorials. Topics include getting started, submitting outpatient and inpatient requests, and other useful features of the tool.
If you have any questions, need assistance with registration, or have technical issues, please contact our iExchange support team at:
iexchange@wpsic.com
.
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Biosimilars Added to Policies
In our
Summer 2018 issue
, we shared that biosimilars may be incorporated into our coverage policies once they receive FDA approval and become commercially available. Recall that a biosimilar is a biological product that is highly similar to and has no clinically meaningful differences from an existing FDA-approved reference product.
The first biosimilars incorporated into our policies were Inflectra® (biosimilar to Remicade®) and Zarxio® (biosimilar to Neupogen®). Recently, other biosimilars have come to market and also included in our policies (e.g., Fulphila® is a biosimilar to Neulasta® and Retacrit® is a biosimilar to Epogen®/Procrit®).
Providers should expect Aspirus Arise to continue to embrace biosimilars as our experience with them grows.
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Prescription Drug Program Updates go into Effect January 1
Information regarding our Prescription Drug Program can be found on our website under the
Aspirus Arise Drug Formulary
page. Specifically, you can access:
- Our Drug Program Policy, which includes how the formulary is developed and maintained, the prior authorization program, how to pursue an exception, and information on generic substitution and quantity limits
- Formulary/Preferred Drug List
If you would like a copy of this information, please contact our Provider Contact Center at
800-332-3297.
FORMULARY/PREFERRED DRUG LIST CHANGES FOR JAN. 1, 2019*
Preferred Drug List Exclusions with Alternatives**
Drug names listed in CAPITALS are BRAND NAME DRUGS. Drug names listed in lowercase are generic drugs.
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Drug Class
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Excluded Medications
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Preferred Alternatives
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Anticoagulants
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PRADAXA, SAVAYSA
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ELIQUIS, XARELTO
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Antiparkinsonism Agents
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NEUPRO PATCH
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pramipexole tablet, pramipexole ER tablet, ropinirole tablet
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XADAGO
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rasagiline, selegiline
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Beta Interferons for Multiple Sclerosis
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EXTAVIA
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AVONEX ADMINISTRATION PACK, AVONEX PEN, BETASERON, PLEGRIDY, REBIF, REBIF REBIDOSE
|
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Blood Glucose Meters & Test Strips
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ABBOTT (FREESTYLE, PRECISION), BAYER (BREEZE,CONTOUR), NATIONAL MEDICAL (ADVOCATE), OMNIS HEALTH (EMBRACE, VICTORY), ROCHE (ACCU-CHEK)*, TRIVIDIA (TRUETEST, TRUETRACK),UNISTRIP, ALL OTHER METERS & STRIPS THAT ARE NOTLIFESCAN BRAND
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LIFESCAN (ONETOUCH)
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Combination Patches
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CLIMARA PRO
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COMBIPATCH
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Corticosteroids (Rectal Formulations)
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CORTIFOAM
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hydrocortisone enema, UCERIS (FOAM)
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Gout Therapy
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DUZALLO, ZURAMPIC
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allopurinol, probenecid
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Growth Hormones
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HUMATROPE, NUTROPIN AQ NUSPIN,OMNITROPE, SAIZEN, SAIZENPREP, ZOMACTON
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GENOTROPIN, NORDITROPIN FLEXPRO
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Hepatitis C
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DAKLINZA, MAVYRET, OLYSIO, SOVALDI
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EPCLUSA, HARVONI, VOSEVI, ZEPATIER
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Hereditary Angioedema
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BERINERT
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CINRYZE, RUCONEST
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HMG & Cholesterol Inhibitor Combinations
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ALTOPREV, ZYPITAMAG
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atorvastatin, lovastatin, rosuvastatin, simvastatin, LIVALO
|
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Long-Acting Beta Agonist Nebulized
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BROVANA
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PERFOROMIST
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Long-Acting Opioid Oral Analgesics
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EMBEDA, OXYCODONE ER
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hydromorphone ER, morphine sulfate, ER, oxymorphone ER, HYSINGLA ER, NUCYNTA ER, OXYCONTIN
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Miscellaneous Topical Dermatological Agents
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ALCORTIN A
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hydrocortisone, mupirocin
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Nonsteroidal Anti-Inflammatory Drugs
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FENOPROFEN (CAPSULE), FENORTHO, NALFON
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fenoprofen calcium (tablet/generic), diclofenac, indomethacin, ibuprofen, meloxicam, nabumetone, naproxen
|
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Ophthalmic Anti-Allergic
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ALOCRIL, ALOMIDE, EMADINE
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azelastine drops, cromolyn drops, olopatadine drops, ALREX, BEPREVE, PAZEO
|
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Ophthalmic Anti-Inflammatory
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FLAREX, FML FORTE, FML S.O.P., MAXIDEX, PRED MILD
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dexamethasone drops, fluorometholone, drops, prednisolone drops, LOTEMAX
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Topical Antiviral Agents
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XERESE CREAM
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acyclovir (tablet/capsule), famciclovir tablet, valacyclovir tablet, ZOVIRAX CREAM
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Topical Corticosteroids
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TOPICORT SPRAY, VERDESO FOAM
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desonide 0.05% (cream/lotion/ointment), desoximetasone 0.25% (cream/ointment)
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* May be subject to prior authorization requirements.
**Aspirus Arise has a pharmacy exception process. Exceptions must be approved in advance for coverage.
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HEDIS Used for Quality Improvement
We annually review and evaluate our Quality Improvement (QI) program and develop a QI work plan that helps us continually improve the quality of care given by our contracted providers. Our QI program and work plan include both clinical and quality service initiatives.
To evaluate program effectiveness, we use the Healthcare Effectiveness Data and Information Set (HEDIS). HEDIS is developed and maintained by the National Committee for Quality Assurance (NCQA), a nonprofit health care quality organization.
Why is HEDIS important to physicians? HEDIS measures track a health plan's and physician's ability to manage health outcomes. Generally, strong HEDIS performance reflects enhanced quality of care. With proactive population management, physicians can monitor care to improve quality while reducing costs.
It's not just about the scores. It's about the woman whose pap smear led to early detection and treatment of her cervical cancer. Or the toddler who didn't get whooping cough because he received the appropriate scheduled immunizations. Or the 65-year-old who kept up with screenings that revealed increased cholesterol. As a result, he received appropriate treatment and potentially avoided another heart attack.
We look forward to working with you, our valued providers, during this upcoming HEDIS season. By working together to meet HEDIS benchmarks, we have the best chance of improving our members' health outcomes and ultimately their quality of life. If you are interested in pursuing collaborative quality opportunities with us, please contact our Quality Department at
QualityImprovement@wpsic.com
.
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Quarterly Medical Policy Updates
The Medical Policy Committee met this quarter and approved the medical policies due for annual review. The policy updates were emailed to providers in October and we have included them in this issue for your convenience.
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. 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
medical.policies@wpsic.com
or 800-333-5003, ext. 78993.
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Medical Policies Up for Review in March 2019
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 800-333-5003, ext. 78993.
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.
Policies currently undergoing review with practicing providers and scheduled for committee discussion in March include:
- Acupuncture Therapy
- Bariatric Surgery
- Biofeedback Treatments and Devices
- Blepharoplasty, Blepharoptosis Repair, Brow Lift, and Related Procedures
- Cell Free Fetal DNA Testing
- Cranial Orthotic Device
- Neuropsychological Testing
- Urine Drug/Alcohol Screening and Testing
- Chiropractic Services
- Occipital Nerve Block and Headache Treatments
- Noncovered Services and Procedures
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Coordination of Care is Crucial Among Behavioral Health and Primary Care Practitioners
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.
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Our Promise:
Make our high-quality health care services cost-effective
.
Integrate your health care so that your personal needs and preferences are considered.
Improve the communities we serve.
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