Aspirus Arise Quarterly
March 24, 2020
In this issue:
  • Doctor's Note
  • Secure Messaging is available
  • Provider Manual Revised for 2020
  • If you need to Appeal
  • Contact us with Authorization Denial Notice Questions
  • Member Rights and Responsibilities
  • Medical Policy Guidelines Available
  • Medical Policy Updates and Review
Doctor's Note
Dear Colleagues,
 
Recently, I had the honor of accepting the Leading Change, Creating Value Award from the Business Health Care Group on behalf of WPS Health Solutions, our parent company.
 
The award recognized WPS for our commitment to improving health care transparency, quality, and cost efficiency. These are goals we don't take lightly. For more than 70 years, we have been committed to providing value to the customers and communities we serve, as well as partners such as yourself.
 
I hope you'll find this issue valuable. It includes details on how to access and use the new secure messaging functionality within our provider portal. Additionally, you can learn more about the following:
 
  • Our updated Provider Manual
  • Member rights and responsibilities
  • Medical policy guidelines
 
We appreciate the care you give your patients and our customers. If you have any questions, please contact me by email at   Jonah.Fox@wpsic.com   or by phone at 608-977-8038.
 
Sincerely,
Jonah Fox, M.D., M.H.A.
Medical Director
Secure Messaging is available
Did you know that Aspirus Arise offers a secure way for you to contact Member Services directly via the provider portal? Secure messages are similar to email, but they can be accessed only through the Aspirus Arise online health portal. You are allowed up to 4,000 characters for your secure message.

To use secure messaging, go to the Provider section on the website and then click the Login button .

  • Patient’s full name
  • Member identification number or SSN
  • Date of birth
  • One of the following:
  • Last four digits of SSN, if SSN was not given above
  • Full address, including the city, state, and ZIP code
  • Full phone number, including area code

When you use our Secure Message Center, you will typically receive a reply within three business days. When a reply has been sent, you will receive a notification on your provider dashboard.
 
If you are not currently using our provider portal, you may register online . Complete the form in its entirety by entering your demographic, practice, and account information.
Provider Manual revised for 2020
Our Provider Manual has a fresh, new look! Check out our website for the updated 2020 Provider Manual . Revisions include adding information about our Credentials Verification Organization (CVO), called Eddy, and updating contact information. Our Provider Manual is designed and produced for our participating providers to promote a clear understanding of our policies and procedures, including:
  • Prior authorizations
  • Claims
  • Eligibility

When accessing the Provider Manual, please refer to our website for the most up-to-date information and policies and procedures.
If you need to Appeal
Aspirus Arise has a provider appeal process when a claim is denied due to:
  • Prior authorization is not obtained
  • Service/treatment is considered not medically necessary
  • Service/treatment is considered experimental, investigational, or unproven

When you fill out the Provider Appeal Form , found at AspirusArise.com , be sure to:

  • Complete the entire form
  • Include the customer number and claim number
  • Attach any additional clinical records

If you're not sure how your inquiry should be handled or where to send it, please contact our Provider Services department at 800-332-3297.
Contact us with Authorization Denial Notice questions
If you have questions when you receive a denial notice for services, contact our Integrated Care Management team to review medical policy guidelines and/or discuss determination rationale.

The Integrated Care Manager (ICM) who initially reviewed the service can discuss the medical necessity denial decision and additional information on the reconsideration process. When indicated, the ICM will initiate the process for peer-to-peer discussion with a physician, appropriate behavioral health care specialist, or a pharmacist reviewer for a health plan member under your care.

Contact us at:
Phone: 608-333-5003
Toll-free phone: 800-333-5003
Fax: 608-327-6300
Member Rights and Responsibilities
The Member Rights and Responsibilities listed below sets the framework for cooperation among covered persons, practitioners, and Aspirus Arise.
 
Our Member Rights and Responsibilities statement specifies that members have:

  1. A right to receive information about the organization, its services, its practitioners and providers, and member rights and responsibilities.
  2. A right to be treated with respect and recognition of their dignity and their right to privacy.
  3. A right to participate with practitioners in making decisions about their health care.
  4. A right to a candid discussion of appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage.
  5. A right to voice complaints or appeals about the organization or the care it provides.
  6. A right to make recommendations regarding the organization's member rights and responsibilities policy.
  7. A responsibility to provide information, to the extent possible, that the organization and its practitioners and providers need in order to provide care.
  8. A responsibility to follow plans and instructions for care that they have agreed to with their practitioners.
  9. A responsibility to understand their health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible.
Medical Policy Guidelines Available
Physicians and other practitioners may obtain the medical policy guidelines used for making medical coverage determinations for an Aspirus Arise member under their care. Medical Polices can be found on our website by clicking the Resources tab and selecting Medical Policies . If you receive a determination and would like to review the medical policy guidelines used in that decision, you may contact us.
 
We also use tools developed by third parties, such as the evidence-based clinical guidelines developed by MCG Health, to assist in administering health benefits. Medical Policies and MCG Health guidelines are intended to be used in conjunction with the independent professional medical judgment of a qualified health care provider.
 
To obtain medical policy guidelines for a specific member review through Integrated Care Management, submit your request via phone, fax, or in writing to:

Aspirus Arise Integrated Care Management
P.O. Box 11625
Green Bay, WI 54307-1625

Phone: 920-490-6901
Toll-Free Phone: 800-332-3297
Fax: 608-327-6300

Please include the subject (procedure/service/treatment) for the medical policy in question, along with the member name and member’s subscriber number. The policy guidelines are an informational resource, not an authorization, an explanation of benefits, or a contract to provide benefits. Receipt of benefits is subject to satisfaction of all terms and conditions of the member's contract in effect at the time services are rendered. Medical technology is constantly changing, and we reserve the right to review and update our medical policy guidelines as necessary.
 
We hope that by providing the specific medical policy guidelines upon request, you may better understand the basis for a decision. Our policy guidelines are based on sound medical and clinical evidence and adopted with the involvement of appropriate medical specialists.
 
If you have questions or suggestions about medical policy guidelines or want to request a specific medical policy or MCG guideline, email medical.policies@wpsic.com  or send the request in writing to Aspirus Arise Integrated Care Management, Attention: Medical Policy Editor, at the address above. 
Medical Policy Updates and Review
The Medical Policy Committee recently met and approved the medical policies due for annual review.

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.

The complete library of our medical policies can be found at  Aspirus Arise Coverage Policy Bulletins  on our website; no password required.

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. 
 
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.

Policies that will be reviewed in the upcoming months include the following:

April 2020
  • Hip Replacement Surgery
  • Knee Replacement Surgery
  • Spinal Cord Stimulators
  • Capsule Endoscopy
  • Reduction Mammoplasty (Breast Reduction Surgery) for Symptomatic Macromastia

May 2020
  • Back and Nerve Pain Procedures – Radiofrequency Ablation, Facet, and Other Injections
  • Back Pain: Sacroiliac and Coccydynia Treatments
  • Back Pain Procedures-Epidural Injection
  • Wearable Cardiac Defibrillator
  • Infertility and Recurrent Pregnancy Loss Testing and Treatment

June 2020
  • Panniculectomy, Abdominoplasty, and Repair of Diastasis Recti
  • Glaucoma Surgical Treatments
  • Tumor Treating Fields (Alternating Electric Field Therapy)
  • Noncovered Services and Procedures
About Aspirus Arise
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.