Aspirus Arise Quarterly
June 23, 2020
In this issue:
  • Doctor's Note
  • Provider Administrators: update your portal account
  • Coordination of care is crucial between behavioral health and primary care practitioners
  • Telehealth and Telemedicine Policy Updates
  • Our RN Case Managers can make a difference for you patients
  • Medical Policy Updates and Review
  • Reimbursement Highlights
  • Utilization Management follows timeliness standards
  • Affirmative statement on incentives
  • Coming Soon! CPAP Rental Prior Authorizations via Phone
  • Enroll in Electronic Claims for faster claims payment
Doctor's Note
During these uncertain times, we at Aspirus Arise want you to know that we are here for you. We understand that providers’ needs and practices are changing, and though we may not have all the answers, we believe in the importance of dialogue and open communication. Here are a few ways in which Aspirus Arise has responded to the COVID-19 public health emergency:

  • Timely filing limits will not be enforced for claims submitted between April 1, 2020 and Dec. 31, 2020.
  • Timely filing limits for all provider appeals are waived for the remainder of 2020.
  • Providers who have received prior authorizations for procedures and services that have been canceled or postponed will be granted an additional 90 days to perform the procedure or service.
  • We have temporarily expanded our coverage of telehealth services.

Please see our website to keep up to date with the latest changes related to COVID-19.

This issue includes information about how designated Provider Administrators can keep your portal accounts current, along with:

  • How to keep up to date with our telehealth policies and find the current versions of our forms
  • Coordination of care between behavioral health and primary care practitioners
  • How our Case Management program can help your patients

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.
WPS Health Insurance/Arise Health Plan Medical Director
Provider Administrators: update your portal accounts
Provider Administrators are responsible for maintaining user access accounts. This includes approving user access requests and regularly reviewing user access to ensure that employees who have terminated or who should no longer have access to the portal are deactivated. Previously, Provider Administrators had to call Web Support or submit a secure message via the provider portal to deactivate or reactivate a user’s account. Effective April 26, 2020, Provider Administrators were granted the ability to deactivate and reactivate portal users registered under the same tax ID number through the Administrator’s portal account.

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

Users registered to the same tax ID as your account will be listed under the Account Details section. To narrow the list you can search using the user’s ID, first or last name, or email address in the Provider User Search section.

Review the Current Status column to verify if the correct users are active or if anyone needs to be deactivated.
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.

If you have any questions regarding this process, contact Web Support at 888-915-5477 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, the date of two remittance advices, and the total amount paid for each.
Coordination of care is crucial between behavioral health and primary care practitioners
Coordination of care among providers is a vital aspect of good treatment planning to ensure appropriate diagnosis, treatment, and referral. The importance of communicating with a 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 customers 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.
Telehealth and telemedicine policy updates
Visit our website for the most up-to-date information regarding our telehealth and telemedicine policy.
Our RN Case Managers Can Make a Difference for Your Patients
Our RN Case Managers are here to help our mutual customers by:

  • Coordinating health care among providers
  • Providing education regarding their health care needs and concerns
  • Supporting and advocating for improved health care experiences and outcomes
  • Locating available community resources
  • Understanding their health insurance benefits
  • Assisting them to become better health care consumers

Our Health Resource Team members are RNs who work one-on-one with your patients, treating each person as an individual with unique needs and challenges. Through confidential conversations, they get to know your patients and assist each one to overcome challenges affecting their health management and care.
Recently, a female in her mid-fifties with type 2 diabetes was having difficulty managing her A1c levels. She would sometimes forget to take her medication and did not follow any exercise program.

Our Health Resource Team member reached out to the customer to offer assistance. Together, they developed a plan to lower her A1c levels through medication management and lifestyle changes including journaling her carbohydrate intake and exercising for 30 minutes at least four times a week. Within a year of working together, the customer was able to cut her fasting blood glucose levels from 200-300 to 80-130, and significantly reduced her A1c levels. Thanks to the help of our Health Resource Team, the patient now has a better understanding of how to manage her Type 2 diabetes and is doing well.

We are here and ready to help your patients. If you have a patient you feel might benefit from the Health Resource Team’s services, please contact Aspirus Arise at 715-843-1061 to speak with a member of the Health Resource Team or email CDMHRT-AspirusInc-Intake@aspirus.org.
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. 77137.

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

July
  • Microprocessor Controlled and Myoelectric Limb Prosthesis
  • Shoulder Replacement Surgery
  • Urine Drug/Alcohol Screening and Testing
  • Cell-Free Fetal DNA Testing
  • Pneumatic Compression Devices

August
  • Cochlear Implants, BAHA, Auditory Brainstem Implants, and Other Hearing Assistive Devices
  • Pectus Excavatum, Pectus Carinatum, and Poland Syndrome Treatment
  • Septoplasty and Rhinoplasty
  • Surgical Removal of Redundant Skin and Face/Neck Lift Procedures

September 2020
  • Negative Pressure Wound Therapy (Wound Vac)
  • Otoplasty and Reconstruction of External Ear
  • Varicose Vein Treatment
  • GI Pathogen Testing Using Multiplex Polymerase Chain Reaction (mPCR)
Reimbursement Highlights
Check out our Reimbursement Policies included on our website under Resources, Support and Education.

Most recent policies listed:

  • Anesthesia Reimbursement Policy
  • Itemized Bill Review for Inpatient Hospital Claims

Future policy:

  • NCCI Surgical Spine Editing

We also encourage providers to use the Claim Edit System ® (CES) application available within our provider portal to view edit results 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 the Request for Provider Access form on our website.

For questions regarding medical coding related to policies, you may contact the Code Governance Committee at codegovernance@wpsic.com .

For questions regarding the policies outside of medical coding, you may contact Provider.Reimbursement@wpsic.com .
Utilization Management follows timeliness standards
As a health plan accredited by National Committee for Quality Assurance (NCQA), we adhere to the timeliness standards specified by NCQA for review of requested services. The standards include:

  • Non-urgent pre-service decisions are determined within 15 calendar days of receipt of the request.
  • Urgent pre-service decisions are determined within 72 hours of receipt of the request.
  • Urgent concurrent review decisions are determined within 24 hours of receipt of the request.
  • Post-service decisions are determined within 30 calendar days of receipt of the request.

These time frames are dependent on the inclusion of necessary clinical information upon receipt of the request. We may request additional medical records if the information submitted to make a determination is not sufficient.

If we cannot make a decision by our standard deadlines, we notify the affected member and requesting provider that an extension is necessary. The date by which we expect to make a decision is included in that notice.

We consistently strive to exceed these standards and meet the needs of our members.
Affirmative Statement on incentives
Utilization Management (UM) decision-making is based only on appropriateness of care and service and existence of coverage. The organization does not reward practitioners or other individuals for issuing denials of coverage. Financial incentives for UM decision-makers do not encourage decisions that result in underutilization.
Coming Soon! CPAP Rental Prior Authorizations via Phone
Aspirus Arise is happy to announce that we will soon be able to process most Continuous Positive Airway Pressure (CPAP) rental prior authorizations over the phone, allowing patients to begin receiving care much more quickly!

Once implemented, you will be able to speak with one of our Intake team members and receive immediate notification if the rental is approved or requires additional review for medical necessity. *

When calling Aspirus Arise for a CPAP rental prior authorization, please be prepared to provide:

  • Sleep study results, including Apnea-hypopnea Index (AHI)/ Respiratory Disturbance Index (RDI)/ Respiratory Event Index (REI)
  • Patient’s diagnoses, including any comorbidities
  • HCPCS codes
  • Ordering physician’s name
  • Date the rental will begin

*Some cases may require additional review by our medical director.
Enroll in Electronic Claims for Faster Claims Payments
COVID-19 continues to affect businesses across the world, including the state of Wisconsin. Aspirus Arise is doing our part to reduce the spread by of the virus by following social distancing guidelines and recommendations. Our Electronic Data Interchange (EDI) teams are dedicated to reducing the impact of COVID-19 on processing claims for our community providers. One example is by alleviating potential processing and payment delays for non-electronic claim submissions.

If you have not already enrolled in the option to submit your claims electronically, you are encouraged to do so by visiting  Aspirus Arise . Filing electronically will help speed up your claims processing.

Aspirus Arise also partners with the nationally recognized Committee for Affordable Quality Healthcare (CAQH) EnrollHub® solution and combines enrollment capabilities for electronic funds transfer (EFT) and electronic remittance advice (ERA). Not only is this faster, but it is at no charge to your practice! 
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.