Winter 2022

Doctor's note

Dear Colleagues, 

WPS Health Insurance is pleased to announce the hiring of a new part-time Medical Director, Dr. Aditya Sukhwal. Dr Sukhwal is board certified in family practice, has extensive prior experience as a Medical Director, and is currently employed as an emergency medicine physician at Gunderson Health. We are excited to add Dr. Sukhwal to our team and are confident that his contributions will enhance our team and help WPS continue to provide excellent services to our customers and providers.  

The last two years have put a strain on our health care system, especially on providers and other front-line workers. With COVID-19 still a concern, flu season upon us, and the emergence of respiratory syncytial virus (RSV), we are facing the possibility of a "tripledemic" this winter.

We urge you to encourage your patients to get vaccinated against COVID-19 and the flu, and to take any other protective measures they feel comfortable with in public places.

In this issue, you'll find stories about:

• Prescription Drug Program updates
• Formulary/Preferred Drug List changes
• Specialty drug and oncology utilization management vendor changes
• Medical policy updates and review

Thank you again for your expertise and the care you show your patients as we prepare for what may be another challenging winter for health care providers. If you have any questions, please contact me by email at Kevin.Rak@wpsic.com.

Kevin Rak, M.D.

Medical Director

Prescription Drug Program updates go into effect Jan. 1

You can find information about our Prescription Drug Program on our website, including:

• Our Prescription 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;
• The Drug Prior Authorization List, which identifies the applicable medications as well as whom to contact to initiate the process; AND
• Formularies/Preferred Drug Lists, which contain the lists of drugs that are covered under the pharmacy benefit including generic drugs, preferred brand-name drugs, specialty drugs, and biosimilars

If you would like a copy of this information, please call our Provider Contact Center at 800-765-4977.

Formulary/Preferred Drug List changes for Jan. 1, 2023

The updates to the Formulary/Preferred Drug List for 2023 are available now.

Select Specialty Drugs and oncology utilization management vendor changes go into effect Feb. 1

WPS is pleased to announce its partnership with Express Scripts, Care Continuum, and eviCore healthcare to provide prior authorization services for select specialty and oncology drugs utilization management (UM) reviews beginning Feb. 1, 2023. Optum PA Manager and Oncology Physician Network (OPN) will continue to review prior authorization requests until Jan. 31, 2023, via phone at 888-515-1357 or fax at 844-262-8479.  

Starting Feb. 1, 2023, requests for authorization(s) of select nonspecialty and specialty pharmacy drugs and select specialty medical drugs will be reviewed by Express Scripts and CareContinuum. Requests can be submitted by using one of the following methods:

Pharmacy drugs

• Log on through your preferred ePA Portal (preferred)
• To learn how to get started, visit bit.ly/express-scripts-easy-epa or use the ePA feature through your electronic health record service, if available 
• Phone: 800-475-1954 
• Fax: 833-933-2367 

Medical specialty drugs

• Log onto evicore.com/pages/ProviderLogin.aspx 
• Phone: 800-475-1954 
• Fax: 833-933-2367 

Medical oncology and radiation oncology requests for authorization(s) will be reviewed by eviCore healthcare. To request an authorization(s): 

• Log onto evicore.com/pages/ProviderLogin.aspx (preferred)
• Phone: 800-475-1954 
• Fax: 800-540-2406

Clinical Guidelines are available on their website, evicore.com/provider/clinical-guidelines. 

WPS will complete updates to its website, drug prior authorization list, and 2023 provider manual prior to Feb. 1, 2023. Please check the WPS website (wpshealth.com/resources/provider-resources/support.shtml) for the latest information.

If you have questions about the vendor changes, please contact the WPS Provider Contact Center at 888-711-1444.

2023 Provider Manual coming soon

The latest revision of the WPS Health Insurance Provider Manual will be available on our website soon. The manual is designed and produced for you, our preferred providers, to promote a clear understanding of our policies and procedures, including provider services, prior authorization, claims, and eligibility.

Now's the time to review user access in the provider portal

The start of a new year is a good time for administrators to review user access in the provider portal—ensuring that employees who should no longer have access to the portal are deactivated and adding users who need access to the portal.

Maintaining user access

To view a list of your registered users, select Profile Management followed by Provider Account Management from the dashboard of your portal account. 

Review the Current Status column to verify if the correct users are active or if any staff members need to be deactivated. You can search using the user’s ID, first or last name, or email address. 

To deactivate a user, click the Deactivate button in the Activate/Deactivate Account column. You should receive a pop-up message asking you to confirm you wish to deactivate the user. Click OK to proceed or Cancel to cancel the request. 

To reactivate a user, click the Activate button in the Activate/Deactivate Account column. You should receive a pop-up message asking you to confirm you wish to activate the user. Click OK to proceed or Cancel to cancel the request.

Adding users

Now is also a good time to add users who need access to the provider portal. Users have the same access as the administrator except for creating and maintaining accounts. To generate an invitation, access the Provider Invite section under Profile Management. Enter the user type, first name, last name, email, and institution name [note: users will only be active for the tax ID associated with the provider administrator] and indicate your understanding. To finalize the request, click the Generate Invitation Email button.

End users will receive an invitation email. Users who receive invitations from provider administrators do not need approval before accessing the portal. 

Invitations that WPS sends will need approval, which can be completed by accessing the Provider Signup Queue under Profile Management.

If you have any questions regarding maintaining and adding user access, contact Web Support at 888-915-5477 Monday through Friday 7:30 a.m. to 5 p.m. or send a secure message through the portal account. When you contact us, please have your tax ID, the user’s name, registered email address, user ID, plus the date of two remittance advices and the total amount paid for each.

Need to register for the provider portal?

Keep us informed of demographic updates

Current customers, potential customers, and providers use our online provider directory—Find A Doctor—to verify whether a provider participates in our provider network and is accepting new patients. 

To keep the directory accurate, market your services to our customers appropriately, and remain compliant with federal guidelines—including the No Surprises Act—we count on you, our preferred providers, to notify us of demographic updates in a timely manner. Updates include, but are not limited to:

• Practitioners joining or leaving your organization
• Changes to practitioner name, licensure, or specialty
• Change in billing or other contact information
• Change in service location
• Acquisition of other medical practice or entity
• Change in tax ID number or legal business name
• Change in ownership

You can notify WPS Health Insurance of provider demographic updates using one of the following methods:

• Practitioner Data Sheet: Allows you to add a new practitioner to your group, forward changes related to a practitioner’s demographic information or practice location, or notify us of a practitioner’s termination from your group.
• Facility Data Sheet: Allows you to add, terminate, or change information specific to facilities, including clinic physical location updates (opening, closing, relocating, etc.). 
• Full File: If you are currently a health system provider that sends us a full file for updates, you may continue to do so. However, you may email time-sensitive updates to GBNetworkDevelopmentDept@wpsic.com. 

Your help in providing demographic updates is very much appreciated by us, our customers, and referring physicians.  

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 WPS Health Insurance Policy Updates 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. 06984.

Policies that will be reviewed in the upcoming months include:

Healthy hearing with Hearing Care Solutions

WPS Health Insurance recognizes the importance of hearing care and the impacts of hearing loss on the overall quality of life. With the right care, prevention, and tools, it has become easier to prevent or adapt to hearing loss. 

All WPS Health Insurance customers receive access to the Hearing Care Solutions healthy hearing program. 

With Hearing Care Solutions customers receive:

• Comprehensive hearing exam at no charge
• Selection of fully digital hearing instruments
• Choice of up to nine major manufacturers
• Choice of more than 4,500 locations nationwide
• And more

Customers who choose a WPS contracted provider will continue to have access to the standard in-network benefits and pricing available through the network. To learn more about Hearing Care Solutions, call 303-407-6813 or visit hearingcaresolutions.com.

Holiday closures reminder

Even though our offices will be closed for these upcoming holidays, you can still access benefits, patient information, claim status, and other key information via our provider portal. We will release holidays for the second half of 2023 as soon as they are available.

New Year's Day (observed)

Monday, Jan. 2

Martin Luther King Jr. Day

Monday, Jan. 16

Presidents Day

Monday, Feb. 20

Memorial Day

Monday, May 29

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