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The Alliance Provider Briefing
October 2019

Privacy Update 

In order to better protect the privacy of our employer-members, we have discontinued publishing a list of our employer-members and their corresponding TPA contacts. Please contact the Alliance Provider Relations Team if you have questions or for more information about this change.  

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You are Invited to a Provider Event in La Crosse, Wis. 

The Alliance Provider Forum:
What Employers Want from Local Health Care Options
Nov. 6, 2019  |  7:30 - 10:00 a.m.

La Crosse, Wis.

The Alliance Provider Forum is a unique opportunity for you to hear from employer members of The Alliance. Representatives from Kwik Trip, Western Technical College, and Wieser Brothers General Contractors will share innovative strategies they are using to design employee benefits plans. Learn how The Alliance is working to connect the dots between how providers and employers can work together to offer high-value health care.   
 
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The Alliance Journey to High-Value Health Care  

The Alliance is here to help self-funded employers on their journey to provide high-value health care to their enrollees. We’ve constructed a roadmap to navigate the challenges to high-value health care success using four core drivers: transparency, provider network design, payment reform and benefit plan design. As a cooperative, we use these four core drivers to create a positive impact on health care cost and quality. Learn more in The Alliance 2019 Annual Report.

Credentialing Process

The Alliance credentialing process verifies training, experience, licensure and competence of an individual to determine if they are qualified to render acceptable quality of care to Alliance members.


The credentialing process currently occurs after contract completion and provider registration. While providers and practitioners are active as of the later of their contract effective or practice start date, WPS and other plans may not consider them in-network until credentialing has been completed and approved.
 

The Alliance partners with other organizations to assist in carrying out the credentialing process, WPS/Arise and Eddy CVO for medical practitioners and Magellan for chiropractic. If you are contacted by one of our credentialing partners, please respond with the requested information or materials promptly. Credentialing application materials are sent to participating providers for completion as applicable.

Workers Compensation Claims Reminder 

This is a reminder that all workers compensation claims should be sent to the employer’s TPA, first. The TPA will forward the claim to The Alliance or the appropriate network as designated in the employer’s workers compensation benefits.

Avoid Disruption in Patient Care 

To avoid patients being impacted by out-of-network services, please notify The Alliance at least 30 days prior to the effective date of any changes to your organization's Tax Identification Number or changes in ownership. Submit a provider update form, which can be found on the Alliance website to let us know about these changes and other important facility updates, such as organization name change, address change, adding a new location or closing a practice location.

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Request to Complete the Leapfrog Survey for Hospitals &
Ambulatory Surgery Centers 
 
The Leapfrog Survey is an important quality survey that allows our employer members, their beneficiaries and the community at large to access critical information to make informed choices about where to receive care. The survey is the only nationally standardized and endorsed measure set that captures performance in patient safety, quality and resource utilization. These measures are “harmonized” with Agency for Healthcare Research and Quality (AHRQ), Centers for Medicare and Medicaid Services (CMS), the Joint Commission and the Centers for Disease Control and Prevention (CDC) to alleviate the reporting burden for facilities. 
 
Hospital survey results are updated monthly and posted on Leapfrog’s website at http://www.leapfroggroup.org/compare-hospitals
 
Hospitals have the opportunity to participate in the 2019 Leapfrog Hospital Survey at http://www.leapfroggroup.org/survey-materials until November 30, 2019. 
 

ASC’s have until November 30, 2019 to submit or update a survey at https://www.leapfroggroup.org/asc-survey-materials/asc-survey-login-and-materials

Please contact Lori Madigan at 608.210.6631 if you have any questions about the reporting process. 

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5510 Nobel Dr., Ste 200, Fitchburg, WI 53711