Note: This article pertains mainly to offices in the Midwest, but you may find the information interesting if you live outside of the Midwest
Following up on my June article, I wanted to update you on insurance plans and who will be managing them at the time of this writing. Plans and which company is managing them are quickly changing, but it’s only fair to keep you in the know as these changes impact your bottom line and admin burden. Here is an updated listing of the payer groups and what is scheduled to happen now and going forward with contracts and claims:
| Plan | Managing company and other information |
| Health Partners | Optum UHC is managing effective 7/1. As of this writing, 1) no pre-auths/clinical submissions are required, and 2) Use Health Partner’s payer ID, 94267 for claims |
| Cigna | Unknown at this time. Possibly direct-contract (groups only) or going to American Specialty Health. Continue sending claims per patient insurance card. |
| Aspirus Medicare Advantage | Whole Health/Tivity |
| The Alliance | Whole Health/Tivity |
| Aetna | Whole Health/Tivity |
| Aspirus Commercial HMO | Unknown at this time |
| Quartz | Direct contract only via invitation from Quartz |
| Zelis | Direct contract for now |
| WPS | Chiropractic Management Services, Brookfield, WI |
Remember!
- Tip: Use the actual payers’ IDs for claims submission.
- Tip: Continue doing your financial consultations after verifying new patient benefits. Patients who are already in the middle of a care plan shouldn’t need a separate exam due to the above changes.
Are patient pre-pay packages looking like a better option for you and your practice? Let us guide you within the can-do’s and can’t-do’s to set up these plans!
Additional Questions? We can help! And we will find an answer for you.
Lisa
920-334-4561