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Policies

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Claim Editing

Arise Health Plan has enhanced its claim editing capabilities with the transition to OptumInsight's claims editing system iCES®. The change in software will enable us to better manage cost effective health care and delivery and equitable, efficient and consistent reimbursement, based upon recognized third party publications such as CCI, CPT, AMA, CMS or other professional organization recommendations.

Web Based Application

The on-line web based application discloses the health plan's payment policies for various code combinations. It can either be used proactively or retrospectively by provider's offices to understand the clinical rationale supporting a particular edit. The application is designed to make our claims' payment policies, related rules, clinical edit clarifications, and clinical sourcing information easily accessible and transparent for all Arise Health Plan contracted providers. Results will reflect the payment policies on the current date, not necessarily the service date.

If you need training or assistance, support is available through our Network Management Department. Please email GBNetworkDevelopmentDept@wpsic.com.