Winter 2018
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, offset Provider Remittance Advice, medical policy updates for this quarter, 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 WPS Health Insurance 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 customers. I hope you find the information provided in this newsletter beneficial to your practice. 
 
Best Regards,
Dr. Catherine Inman
Provider portal enhancements

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.
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 t wo examples of claims paid by WPS 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 should 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.
iExchange® makes prior authorizations easier
 
Only 20% of prior authorizations are being submitted electronically to WPS Health Insurance 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:
  1. Go to wpshealth.com 
  2. Click on the Resources link and, under the Provider Resources heading, select iExchange
  3. Click Register
  4. 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 on how to register and use iExchange, which can be found here.
 
If you have any questions, need assistance with registration, or have technical issues, please contact our iExchange support team at: iexchange@wpsic.com .
Prescription Drug Program updates go into effect Jan. 1
 
Information regarding our Prescription Drug Program can be found on our website under the WPS 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  888-711-1444.
 
 
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.
 
Drug Class
Excluded Medications
Preferred Alternatives
Anticoagulants
PRADAXA, SAVAYSA
ELIQUIS, XARELTO
Antiparkinsonism Agents
NEUPRO PATCH
pramipexole tablet, pramipexole ER tablet, ropinirole tablet
XADAGO
rasagiline, selegiline
Beta Interferons for Multiple Sclerosis
EXTAVIA
AVONEX ADMINISTRATION PACK, AVONEX PEN, BETASERON, PLEGRIDY, REBIF, REBIF REBIDOSE
Blood Glucose Meters & Test Strips
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
LIFESCAN (ONETOUCH)
Combination Patches
CLIMARA PRO
COMBIPATCH
Corticosteroids (Rectal Formulations)
CORTIFOAM
hydrocortisone enema, UCERIS (FOAM)
Gout Therapy
DUZALLO, ZURAMPIC
allopurinol, probenecid
Growth Hormones
HUMATROPE, NUTROPIN AQ NUSPIN,OMNITROPE, SAIZEN, SAIZENPREP, ZOMACTON
GENOTROPIN, NORDITROPIN FLEXPRO
Hepatitis C
DAKLINZA, MAVYRET, OLYSIO, SOVALDI
EPCLUSA, HARVONI, VOSEVI, ZEPATIER
Hereditary Angioedema
BERINERT
CINRYZE, RUCONEST
HMG & Cholesterol Inhibitor Combinations
ALTOPREV, ZYPITAMAG
atorvastatin, lovastatin, rosuvastatin, simvastatin, LIVALO
Long-Acting Beta Agonist Nebulized
BROVANA
PERFOROMIST
Long-Acting Opioid Oral Analgesics
EMBEDA, OXYCODONE ER
hydromorphone ER, morphine sulfate, ER, oxymorphone ER, HYSINGLA ER, NUCYNTA ER, OXYCONTIN
Miscellaneous Topical Dermatological Agents
ALCORTIN A
hydrocortisone, mupirocin
Nonsteroidal Anti-Inflammatory Drugs
FENOPROFEN (CAPSULE), FENORTHO, NALFON
fenoprofen calcium (tablet/generic), diclofenac, indomethacin, ibuprofen, meloxicam, nabumetone, naproxen
Ophthalmic Anti-Allergic
ALOCRIL, ALOMIDE, EMADINE
azelastine drops, cromolyn drops, olopatadine drops, ALREX, BEPREVE, PAZEO
Ophthalmic Anti-Inflammatory
FLAREX, FML FORTE, FML S.O.P., MAXIDEX, PRED MILD
dexamethasone drops, fluorometholone, drops, prednisolone drops, LOTEMAX
Topical Antiviral Agents
XERESE CREAM
acyclovir (tablet/capsule), famciclovir tablet, valacyclovir tablet, ZOVIRAX CREAM
Topical Corticosteroids
TOPICORT SPRAY, VERDESO FOAM
desonide 0.05% (cream/lotion/ointment), desoximetasone 0.25% (cream/ointment)
 

 
*May be subject to prior authorization requirements.
**WPS has a pharmacy exception process. Exceptions must be approved in advance for coverage.
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 are also included in our policies (e.g., Fulphila® is a biosimilar to Neulasta®, and Retacrit® is a biosimilar to Epogen®/Procrit®).
 
Providers should expect WPS  to continue to embrace biosimilars as our experience with them grows .
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.

Note: The mailing sent on Oct. 31, 2018 included an error. Under Prior Authorization Updates and Reminders, the second bullet should read: Cell Free Fetal DNA testing will be denied for non-high-risk, not "no-high-risk pregnancies." The correct version is available through the above link and on wpshealth.com.
 
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.
 
The complete library of our medical policies can be found at WPS Medical Policies on our website; no password required.
 
Specific questions or comments regarding development of policy content may be directed to the Medical Policy Editor  medical.policies@wpsic.com or 800-333-5003, ext. 78993.
Offset Provider Remittance Advice (PRA)

If you have questions on how to read your PRA as it relates to offset claims, please see our tip sheet, now posted under the Forms and Documents section of our  Resources web page. 
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
Coordination of care is crucial among behavioral health and primary care practitioners
Coordination of care among providers is a vital aspect of good treatment planning, ensuring appropriate diagnosis, treatment, and referral.

The importance of communicating with the customer's other health care practitioners cannot be overstated. This includes primary care practitioners (PCPs) and medical specialists, as well as behavioral health practitioners.

Coordination of care is especially important for customers with complex medical care needs and those referred to a behavioral health specialist by another health care practitioner. All practitioners should obtain the appropriate permission from these customers to coordinate care among behavioral health and other 
health care practitioners at the time treatment begins.

We expect all health care practitioners to have a mechanism in place to: 
  • Discuss with the customer the importance of communicating with other treating practitioners
  • Obtain a signed release from the customer and file a copy in the medical record
  • Document in the medical record if the customer refuses to sign a release
  • Document in the medical record if you request a consultation
  • If you made a referral, transmit necessary information, and if you are furnishing a referral, report appropriate information back to the referring practitioner
  • Document evidence of clinical feedback (i.e., consultation report) that includes, but is not limited to:
    • Diagnosis 
    • Treatment plan
    • Referrals
    • Psychopharmacological medication (as applicable)
With this collaborative approach, we can achieve excellent coordination of care and help improve health outcomes. 
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