- Doctors Note
- Exciting news for Aspirus Arise
- Telehealth and Telemedicine Policy updates
- Getting a flu vaccine is more important than ever
- Updating demographic and the provider directory
- Reimbursement highlights
|
|
- Provider portal delivers patient eligibility and benefits
- Medical policy updates and review
- Get paid faster and reduce administrative paperwork with Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA)
- Incomplete appeal forms cause delays
|
|
Dear Colleagues,
Here at Aspirus Arise, we are extremely grateful for health care providers and their staff during this time of change and uncertainty.
We remain committed to communicating important information and updates to you.
In this issue, you can read about:
- Changes to the Aspirus Arise name
- The importance of receiving the flu vaccine in light of the COVID-19 public health emergency
- How to make updates to the provider health directory
- How you can use the provider portal to search patient eligibility and benefits
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
|
|
Exciting news for Aspirus Arise |
Aspirus Arise is excited to announce our rebrand to Aspirus Health Plan!
Aspirus Arise was created in a partnership with WPS Health Solutions to fulfill Aspirus’ mission “To heal people, promote health and strengthen communities” by serving patients through the integration of all parts of a comprehensive health system.
In 2019, Aspirus purchased WPS’ shares of the partnership. Starting on Jan. 1, 2021, Aspirus Health Plan will be working with PreferredOne as our new commercial third-party administrator (TPA), based in Golden Valley, Minn. Aspirus Health Plan will also be working with Navitus Health Solutions, based in Madison, Wis., for pharmacy benefit manager (PBM) services.
Consistent with our mission, Aspirus Health Plan will launch a Medicare Advantage plan administered by UCare, based in Minneapolis, Minn., to serve the senior population in our community. Plans will be available during the Annual Enrollment Period this fall from Oct. 15–Dec. 7. Aspirus Health Plan looks forward to continuing to partner closely with providers and work to improve the services offered to our members.
|
|
Telehealth and Telemedicine Policy updates |
Visit our website for the most up-to-date information regarding our telehealth and telemedicine policy.
|
|
Getting a flu vaccine is more important than ever |
As COVID-19 continues to spread throughout Wisconsin, it is more important than ever that our members get the flu vaccine. With your help, we can achieve better outcomes by being proactive and prescriptive about the flu vaccine. We realize the number of in-person office visits at a clinic or facility are declining, making it more difficult to offer the flu vaccine. We encourage you to discuss the importance of the flu vaccine and where members are able to obtain it. More information on where members can get a flu vaccine can be found by visiting vaccinefinder.org.
Contingency plans to lessen the risk of exposure to respiratory germs, like COVID-19, are being developed by the Centers for Disease Control and Prevention (CDC), health care workers, and state and local health departments. According to the CDC, it is likely that both the flu viruses and the virus that causes COVID-19 will be prevalent in the fall and winter months, thus making flu vaccination paramount to reducing the impact of respiratory illnesses in the population. For interim guidance for immunization services during the COVID-19 pandemic, visit cdc.gov/vaccines/pandemic-guidance/index.html.
|
|
Updating demographics and the provider directory |
|
Current members, potential members, and providers use our online provider directory, Find A Doctor, to verify whether a provider participates in our provider networks.
To keep the directory up to date, we count on you, our participating providers, to notify us of additions, deletions, and changes in a timely manner. This allows us to market your services to our members appropriately. It also assists users looking for a primary care practitioner, as well as those who are referred to a specialist to find a provider in the network.
We highly recommend that you periodically check our Find A Doctor tool to ensure we have your information listed accurately. Items to check include:
- Name
- Gender
- Specialty
- Hospital affiliations
- Medical group affiliations
- Accepting new patients
- Languages spoken by the physician or clinical staff
- Office locations and phone numbers
If you find an error, please send any revisions to info@aspirusarise.com. Your help in maintaining our directory is very much appreciated by us, our members, and referring physicians.
|
|
Most updated policy:
We also encourage providers to use the Claims Edit System® (CRS) application available within our provider portal to view edits and rationale that will be applied to specific code combinations. The CES application is available to all contracted providers through our provider portal. If you do not currently have a provider account, please complete a Request for Provider Access on our website.
For questions regarding medical coding related to policies, you may contact the Code Governance Committee at codegovernance@wpsic.com.
|
|
Provider portal delivers patient eligibility and benefits |
|
To better help you care for our members, our provider portal allows you to search benefits, patient’s network, insurance entity name, patient information, subscriber and policy details, and other insurance information through the Patient Eligibility link—24 hours a day, seven days a week.
To verify patient eligibility, simply click on Patient Eligibility Search and enter the minimum search criteria of:
- Subscriber ID + Date of Birth + Eligibility as of Date; or
- Last Name (partial name accepted) + Date of Birth + Eligibility as of Date; or
- First Name (partial name accepted) + Date of Birth + Eligibility as of Date
When you press the Search button, matching records are displayed. Click Patient name to see more patient details, including:
- Plan effective and termination dates
- Insurance entity
- Network name
- Copay
- Coinsurance
- Deductible
- Out-of-pocket balances
Information can be exported as a spreadsheet or PDF file by using icons in the upper right corner of your screen.
For complete instructions on how to use the functions of our provider portal, please see the Provider Portal User Guide on our website.
|
|
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.
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 call 800-333-5003, ext. 77137.
Policies that will be reviewed in the upcoming months include the following:
|
|
October 2020
- Autologous Chondrocyte Implantation (ACI) and Matrix-induced Autologous Chondrocyte Implantation (MACI)
- Gender Dysphoria Treatment
- Osteoarticular Transfer System (OATS) Procedure and Mosaicplasty
- Hip Replacement Surgery
- Knee Replacement Surgery
- Spinal Cord Stimulators
|
|
November 2020
- Magnetic Resonance Angiography (MRA)
- Magnetic Resonance Venography (MRV)
- Magnetic Resonance Spectroscopy (MRS)
- Nuclear Magnetic Resonance Spectroscopy (NMRS)
- PET Scan (Positron Emission Tomography)
- Fecal Microbiota Transplant (FMT) Topic
|
|
December 2020
- Non-Covered Services Policy
- Telehealth/Telemedicine
|
|
Get paid faster and reduce administrative paperwork with Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) |
|
Did you know in addition to submitting claims electronically, you can also receive your Provider Remittance Advice and claim payments electronically? We commonly refer to these features as Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT).
The ERA replaces the paper version of the Remittance Advice (RA). Aspirus Arise delivers 5010 835 versions of all remittance files that are compliant with the Health Insurance Portability and Accountability Act (HIPAA). You can receive your ERA directly from Aspirus Arise or through your clearinghouse.
When you enroll in EFT, Aspirus Arise claims payments are deposited directly in the bank account(s) of your choice.
For additional assistance completing ERA and EFT enrollment please contact the CAQH Enrollment Help Desk toll-free at 844-815-9763.
If you have any additional questions or concerns, please contact us at:
EDI Help Desk Team - 800-782-2680 (option 1)
EDI Marketing Team - 800-782-2680 (option 2)
|
|
Incomplete appeal forms cause delays |
|
If you wish to dispute a claim denied for prior authorization not obtained or denied for services considered not medically necessary or experimental/investigational/unproven, you must submit the dispute in writing via the Provider Appeal Form found on our website.
To ensure your request is reviewed, be sure to complete the form in its entirety. Information we frequently find missing on submitted forms include:
- Claim Specifics:
- Member Number
- Claim Number
- Date of Service
- Contact information for review results:
- Name
- Phone number
- Fax number
- Address
- Additional clinical records to support medical necessity of treatment or device
The provider appeal form must be submitted within 45 days of the date of denial listed on your Provider Remittance Advice (PRA). Because processing provider appeals may take up to 60 days following receipt, we ask that you refrain from status checks until 60 days have passed.
|
|
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.
|
|
Quick Links
31166-080-1706
|
|
|
|
|
|
|
