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» PATIENT INQUIRY

» CLAIM CENTER

» FIND A DOCTOR

» CLAIMS EDITING SYSTEM (CES)

PROVIDER WEBSITE SITE ADMINISTRATOR GUIDE

©2018 WPS Health Plan, Inc. All rights reserved. JO7048 28898-085-1801

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ADMINISTRATIVE USER GUIDE INDEX

Introduction ............................................................................................................................................ 3

Registering as the Provider Administrator ................................................................................ 3Administrator Invitation ..................................................................................................................... 3Administrator Registration ............................................................................................................... 4Registration Message ...................................................................................................................... 4

Accessing the Website ...................................................................................................................... 5

My Account ......................................................................................................................................... 5Logging In ........................................................................................................................................... 5

Site Administrator Responsibilities ............................................................................................ 6Invite Sub Users ................................................................................................................................ 6Invite Individual Sub Users .............................................................................................................. 6Schedule Invites to Individual Sub Users .................................................................................... 6Invite Multiple Sub Users ................................................................................................................ 7Schedule Invites to Multiple Sub Users ...................................................................................... 7

Manage Users ........................................................................................................................................ 8User Management ............................................................................................................................. 8General Information Tab .................................................................................................................. 9Invite Status Tab ................................................................................................................................ 9Admin Status Tab ............................................................................................................................ 10Delete User Tab ............................................................................................................................... 10

Arise Health Plan Provider Website Features ....................................................................... 11Patient Inquiry .................................................................................................................................. 11Patient Information .......................................................................................................................... 12Claim Center .................................................................................................................................... 13Claim Editing .................................................................................................................................... 14Claim Editing System (CES) ........................................................................................................ 15Navigating CES ............................................................................................................................... 15Submit Claims and WPS Community Manager ...................................................................... 16Find a Doctor .................................................................................................................................... 17System Notes .................................................................................................................................... 17

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INTRODUCTION

Welcome to the Arise Health Plan Provider website. The enhanced website allows providers access to benefits, patient information, claims, subscriber and policy details, and other insurance information through the Patient Inquiry tab. The Claim Center tab allows providers to search for claims, check claims for errors or omissions prior to submission, and submit claims. You can also view the providers within a patient’s current network and look for providers within selected networks.

Arise encourages large facilities to use the electronic 270/271 Health Care Eligibility/Benefit Inquiry and Information Response transaction and the electronic 276/277 Health Care Claim Status Request and Response transaction.

REGISTERING AS A PROVIDER ADMINISTRATORAdministrator InvitationWe encourage providers with multiple locations to take advantage of our electronic 276/277 transactions. Contact Arise EDI at 800-782-2680, option 1 to learn more.

To register, send an email to register@wpsic.com with the following information: Administrator name, email address, tax ID, practice name, and a list of all clinic locations (including addresses).

You will receive an email invitation to register. Click on Begin Registration within the body of the email. The first administrator invited for that tax ID will need to complete the registration in order for any other administrators to register. The first administrator will have to approve additional administrators that register.

Invitation to register for your account When you click the Begin Registration link, it will open a web page to initiate the registration process. Click on Begin My Registration to start.

Read and agree to the “Terms, Conditions, and Disclaimers” by checking the I Agree box and clicking Continue.

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Administrator RegistrationComplete the Provider Registration form and click Register.

Registration MessageYou will receive the following message.

If you are not the first administrator to be invited to register for this location, you will have to be approved by the original administrator.

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ACCESSING THE WEBSITEMy AccountAccess the website at arisehealthplan.com.

Logging InLog in with the User ID and Password you created.

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SITE ADMINISTRATOR RESPONSIBILITIESThe Site Administrator has the capability to invite additional users within the office that will need to access this system. These accounts are called Sub User accounts. The Sub User accounts will only be active for the location specified by the Site Administrator. The Sub Users will have the same access as the Site Administrator for these locations, except for creating accounts.

In addition to adding new Sub User accounts, the Site Administrator has the ability to edit, delete, and update the profiles for the Sub User accounts as needed.

Please contact the Arise EDI Department at 800-782-2680, option 1 for assistance regarding functions of the website and password issues for either the Site Administrator or Sub Users.

Invite Sub UsersCreate user accounts for other staff, if required.

Invite Individual Sub UsersTo invite each user for this location separately, complete the Enter Individual Invitees fields shown below and click Add to List.

Schedule Invites to Individual Sub UsersConfirm information transferred to Step 2 and click Schedule Invitations.

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Invite Multiple Sub UsersTo invite multiple users at once, choose Upload a list of Invitees.

Click on CSV file to open a spreadsheet.

Row 1 is filled in with questions. Enter the answers to the questions into rows 2–101, Columns A–E for each user. Column A: Is this User an Administrator? (Y or N) Column B: Invitee First Name (25 characters or less) Column C: Invitee Last Name (25 characters or less) Column D: Invitee Email Address (40 characters or less) Column E: Email Delivery Date (Current or a future date MM/DD/YYYY)

The spreadsheet will look like this:

Save the spreadsheet on your computer. Click on Browse from the Upload a list of Invitees tab and select the spreadsheet you saved. Verify name in upload section is correct. Click Upload file.

Schedule Invitations to Multiple Sub UsersConfirm information transferred to Step 2 and click Schedule Invitations.

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MANAGE USERSUser Management

This section lists all registered and pending Sub Users that have been assigned by Administrators. Each user has the following information displayed: Name, E-Mail Address, Role, Invitation Date, Status, Approve Registration, and Delete User.

• Approve users that have registered and are pending an Administrator Approval.• Delete users that may have been invited incorrectly.• View detailed information on the user by clicking the user Name. — The Name link opens four new tabs: • General • Invite Status • Admin Status • Delete User

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General Information TabThe General tab contains the invitation information and the registration status of all users.

Invite Status TabInvite Status tab allows you to resend the invitation when necessary.

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Admin Status TabThe Admin Status tab allows the Administrator to change administrative access for all users.

Delete User TabThe Delete User tab allows you to delete users.

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ARISE HEALTH PLAN PROVIDER WEBSITE FEATURESThe Arise Provider website offers the following:

• Patient Inquiry: Search benefits, patient’s network, insurance entity name, patient information, subscriber and policy details, and other insurance information

• Claim Center: Search for claims, check claims for errors or omissions prior to submission, and link to electronic claim submissions

• Find a Doctor: View the current providers within a patient’s network and look for doctors within selected networks

• CES: Providers can enter procedure codes, modifiers, diagnosis codes, date(s) of service, patient gender, date of birth, and place of service parameters in order to review results specific to the procedure codes being queried

Patient InquiryTo access patient information, click on Patient Inquiry.

You may search by Patient ID and Birthdate or by First and Last Name and Birthdate.

YOU CAN SEARCHBY EITHER

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Click on the Patient name for more patient details.

If the search does not yield any results, the following error will be produced. Users will be directed to refine their search or call Customer Service at 800-765-4977.

Information in regard to the 270/271 Transaction as an alternative option for claim eligibility can be located in the EDI section of the WPS Health Insurance website at wpsic.com/edi/companion-guide.shtml.

Patient InformationThis screen displays information regarding effective and term dates, other insurance, primary care providers, and more.

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Claim CenterThe Claim Center allows providers to search for claims by patient or claim ID, check claims for errors or omissions prior to submission, submit electronic claims using the Submit Claims button, or use the WPS Community Manager to self-register for EDI, access lines of business and transactions, and retrieve and submit agreements.

Information regarding the 276-277 Transaction as an alternate option to the Claim Center can be found in the EDI section of the WPS Health Insurance website at wpsic.com/edi/companion-guide.shtml.

You may search for claims by the member name or claim ID. In the Advanced Search, you can search by Type (Medical or Hospital) and the service dates (cannot exceed 60 days), Member, and Provider. Clicking on the magnifying glass icon by the Member field takes you to the Patient Inquiry Screen. Once you have located the patient, click on the name and this will populate the Member field on the Advanced Search.

YOU CAN SEARCHBY EITHER

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When the search is complete, you will see the Claim ID, Service Dates, Patient (ID), Service Provider’s National Provider Identifier (NPI), and Status for the claim(s) you requested. For additional information, such as ANSI codes, click on the Claim ID number.

If no claims are found matching the search criteria, you will be directed to the appropriate claims processing area. If the claim was submitted electronically, you will be directed to contact EDI at 800-782-2680, option 1 to verify receipt of the claims and status of your file. If the claim was submitted on paper, then you will be directed to contact Customer Service at 800-765-4977.

Claim Editing

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Claims Editing System (CES)In the interest of payer transparency, Arise has developed an interactive portal within the Arise Provider website at arisehealthplan.com. Providers can proactively determine how a particular code combination will process.

Providers can enter procedure codes, modifiers, diagnosis codes, dates of service, patient gender, date of birth, and place of service parameters in order to review results specific to the procedure codes being queried. The results and rationale are displayed and can be downloaded as a PDF. This allows greater transparency of the code combination edits being used at Arise.

Upon entering the CES, this is the first screen you see.

Navigating CES1. Professional Claim Entry—Enter all applicable fields and then click Submit.

Note:• Begin Date of Service, End Date of Service, and patient Date of Birth are each a drop-down calendar; select the mm/dd/yyyy

• Patient Gender is a drop-down selection

• Claim type defaults to Commercial

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2. Results—The results will display on this page.

3. Export to PDF—Clicking this button creates a PDF file for the provider to print the results.

Submit Claims and WPS Community Manager

Submit ClaimsThis button directs you to WPS Gateway Express, where you can log in and submit your claims electronically. Direct Submitters are required to have a WPS Submitter ID in order to log in and submit claims.

WPS Community ManagerWPS Community Manager is a full self-service tool and allows your office to self-register for EDI as well as self-manage your account details. This includes the external users’ ability to create their own accounts, register for lines of business and transactions, and retrieve and submit agreements.

For more information on submitting claims or WPS Community Manager, please contact our EDI Help Desk at 800-782-2680, option 1.

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Find a DoctorThis tab allows you to locate an in-network provider by name, specialty, or location.

Select Visitors—general provider panel listing and enter your search criteria.

System NotesAfter 30 minutes of inactivity, you will receive the following pop-up warning that you are about to time out.

To continue your session, you can click on the Continue Session button to return to your activity or Log Out to quit.

If you actually time out, the system will return you to the login screen.