In This Issue
Network Updates
Provider Registration Reminder
Credentialing Corner
Policy Changes
New Claims Form
Online Provider Account Updates

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The Doctor's Note
April 2014

Dear Colleagues:


After a long winter, it's bound to feel like spring any day now!


Here at WPS, we're getting active for spring through a variety of employee wellness challenges and programs. We're also continuing to promote good health for our members.


Wellness is an important part of WPS. With the warm weather just around the corner, it'll be easier to "stay well!"


WPS Employee Wellness challenges and programs:

  • On-campus group exercise classes
  • "Break the Fast" Challenge
  • "Build a Better Core" Challenge
  • 60 miles in a month challenge
  • 10,000 and 70,000 steps challenge
  • 8 glasses of water a day challenge

In addition to wellness, we firmly believe in our tradition of excellence through every season. In light of that tradition, we've been recognized as one of the World's Most Ethical Companies for 2014 by the EthisphereŽ Institute. This is the FIFTH TIME in a row that WPS has earned this distinction, and we're the only health insurance company in the world to do so.


To carry on the tradition of excellence, we've partnered with some great new companies this spring to provide better service to you and our members. Our NEW specialty drug provider is Diplomat Specialty Pharmacy. Our NEW specialty healthcare management company, overseeing our chiropractic network and rehabilitative therapy services, is HSM, Inc.  


Read on for more information! We hope you enjoy this edition of our WPS Provider Connection!


Best Regards,


Viren Bavishi, D.O.

Network & Quality Medical Director 

Network Updates

NEW WPS specialty drug provider: Diplomat Specialty Pharmacy


On April 1, Diplomat Specialty Pharmacy began handling specialty prescription drugs for our WPS members. Diplomat stocks many of the latest, hard-to-find medications and provides free delivery of all medications plus necessary supplies. The company includes educational materials to help WPS members get the most benefit from their therapy.


Diplomat replaces Accredo (owned by Express Scripts) and was selected primarily because of its industry reputation for superior customer service. Please note that this change affects an extremely small number of members, and as a valued WPS provider, you shouldn't notice much of a change either. 


Express Scripts will continue as the Pharmacy Benefits Manager (i.e. claims processor) and mail order provider for all prescription drugs.




HSM Reminder for Chiropractic and Rehabilitative Therapy Providers


We recently announced that WPS has teamed up with HSM, Inc., to manage and streamline utilization (UM) reviews effective April 1, 2014. With this relationship, some chiropractic and all rehabilitative therapy (PT/OT/ST) services will be subject to HSM oversight, helping to ensure that services are delivered at the appropriate time and level of care.


The  WPS iExchange log in page provides a convenient link to the HSM portal to submit requests for rehabilitative therapy services. If you already have an account with HSM, you can use the same account to request services for WPS members. If you do not have an existing account, please contact HSM Provider Services at (800) 432-3640, option 3, for assistance.


Effective July 1, 2014, all chiropractic services will be managed by HSM. This will include credentialing, UM, provider contracting, and network management.


If you have questions concerning the transition, please contact:

  • WPS: See the WPS Provider Manual for your provider relations contact
  • HSM: Traci Wills, (651) 287-4722
  • ChiroCare: Hans Hildebrand, (414) 476-4733, extension 404

Thank you for serving as a WPS preferred provider. We value your participation and look forward to working with HSM and you into the future.

Provider Registration Reminder

Reminder: Logging into your online WPS account is easier!


Previously, your login registration for your online provider account was tied to your tax ID and a specific location. This meant you would have had to create multiple registration logins for your online account to get to claims status and other information for your various locations.


That all changed!


Since Thursday, April 10, when you log into your online provider account, you can see ALL claims status for any of the claims billed with your tax ID. You do NOT need multiple logins for specific locations to access this information.


However, you will still need separate logins for different tax IDs.



Multiple logins tied to tax ID + specific location



One login per tax ID


What you need to do:

Pick and use one of your current logins for your tax ID. Discontinue use of all other logins.  


It's that easy! Any unused provider account logins will expire after 180 days.


Have any questions? Give us a call at 1-800-782-2680.

Credentialing Corner

Credentialing Reminder


Do you have new practitioners joining your practice? Remember to have them credentialed!


WPS requires credentialing review and approval of all contracted providers. Credentialing approval is required before new practitioners begin seeing WPS members. Your practitioners may experience a delay in network participation if credentialing approval is not obtained prior to their start date.


You may notify WPS of new providers, terminations, or changes by completing the appropriate Practitioner or Facility Data Sheet found on our website. Please submit requests to add a new practitioner well in advance of their start date, or as soon as reasonably possible.


WPS has partnered with the Council for Affordable Quality Healthcare (CAQH) for obtaining credentialing information. Please ensure your practitioners regularly update their information on the CAQH website.


Still have credentialing questions? Please see the  WPS Provider Manual 

or contact our credentialing team at

Med Policy Changes
The following medical and pharmacy policies were approved at the 03/07/2014 WPS Medical Policy Committee meeting.


WPS welcomes your feedback regarding research and development of criteria in the Medical Policies. Comments regarding specific criteria should include supporting references from peer-reviewed high level scientific literature. Please respond to


Acupuncture Therapy


Bariatric surgery


Blepharoplasty, Blepharoptosis, Brow Lift


Chelation Therapy

Cranial Orthotic


Intervertebral Disc Therapy


Neuropsychological Testing

Non-Covered Services


Percutaneous Vertebroplasty/Kyphoplasty/Sacroplasty

PET scan


Selective Internal Radiation Therapy (SIRT)


Varicose Vein Treatments


New Claims Form



The National Uniform Claim Committee (NUCC) recently announced changes to the CMS-1500 claim form. This new form has been approved by CMS (Centers for Medicare and Medicaid Services) and the Office of Management and Budget (OMB).


Effective April 1, 2014, WPS will accept paper claims on only the new claim form, OMB-9838-1197 FORM 1500 (02-12). Please share this information with your billing staff to ensure prompt payment for your services.


WPS continues to encourage providers to use electronic claim submission. This can assist to streamline your administrative processes, protect your patients' information, and may result in faster claim processing and payment. To enroll, please contact the WPS EDI (Electronic Data Interchange) at 1-800-782-2680, option 4.

Online Provider Account Updates

NEW Check out your Provider Remittance Advices online!


Now you can view your Provider Remittance Advices (PRAs) online using Emdeon Payment Manager or Emdeon Vision for Claim Management.


Simply select WPS Health Insurance (ID: SX022) from the Payer list and access the exact PRA images you receive in the mail-now all in one place and available 24 hours a day!


Use your regular Emdeon login:


Need to register? Visit to register for Emdeon Vision; it's FREE!


Or call 1-877-EMDEON-6 (1-877-363-3666) to get set up.




Secure messaging: Get information for multiple facilities with one simple online request!


Secure email messaging can do the job that regular email can't: comply with HIPAA regulations! That means we can email you the detailed information you need easily and quickly.


Plus, when you want claim status information across multiple locations, one secure email is all it takes. Save a phone call. Log in to your Provider portal and try out secure messaging today!

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