Providing Active Care
for Active People

TPR Pilot Study

                  Wisconsin State Business Development Report               
NATA Third Party Reimbursement Pilot Project


Monthly Resources

2017 January Wisconsin Monthly Report
December 2016 TPR Report
December 2016 State of Wisconsin DMS Update

 

 

The WATA Third Party Reimbursement Initiative
Owner and CEO of Orthovise: Joe Greene

In conjunction with state and national leadership, we have developed a well designed strategic plan to advance third party reimbursement initiatives in the State of Wisconsin that will implement diverse pilot programs at key locations around the state. This will allow us to learn best practices, but also allow us to identify the educational needs of employers and members. Please be patient with this process as we want to create a well designed and coordinated roadmap for those athletic trainers and employers that wish to pursue third party reimbursement for athletic trainers under the athletic training scope of practice in the State of Wisconsin. This plan will also include advocacy efforts with payors and employers.

Important educational materials and updates will be posted here regularly as we work on your behalf to advocate for the profession of  athletic training in the State of Wisconsin. We will be adding FAQ’s to this page and we will also have the functionality to distribute communication via multiple social media outlets. This will allow us to optimize communication with you, the membership. This is very important to WATA leadership, and we couldn’t agree more. We want to keep you updated as effectively as possible.

We have assembled an exceptional and dedicated team to this cause that is excited to work on your behalf.  These individuals will be working as part of our company to move our mutually agreed upon initiatives forward. We are building the content for these individuals now and will post it below within the next week.

All this said, we cannot accomplish what we need to without the support of the membership and volunteers. With your support, we will work extremely hard to enable opportunities now and in the future for you.

WATA Third Party Reimbursement Pilot Sites

Thank you to our confirmed Pilot Site Institutions! Our pilot site program launched on 7/1/2015.

Portage Divine Savior Hospital
Columbus Community Hospital
Community Health Network
Fort Healthcare
Grant Regional Health Center
Baldwin Area Medical Center
Aurora BayCare Medical Center

The WATA has identified and secured approval from seven healthcare entities that have both practice type and geographic diversity to serve as pilot sites. In order to be a pilot site, each organization has committed to supporting the processes associated with billing third parties for autonomous rehabilitation services delivered by an athletic trainer in an outpatient rehabilitation clinic or through a physician office. The 97005 and 97006 and/or other 97000 series codes will be utilized and supported at pilot sites. Pilots will last 12 months in duration and implementation began on 7/1/2015.

For more detailed information specific to what is required of pilot sites, please see the following document:

Wisconsin Pilot Program Requirements and Description

If you have questions and believe that your institution would explore being a pilot site or consider utilizing athletic trainers in a reimbursable capacity, please contact Joe Greene @ joegreene@orthovise.com or at (608) 220-6196.

 See more at: http://www.orthovise.com/watasbd/

Follow social media for updates: 

OrthoVise Web Presence: http://www.orthovise.com/watasbd
Twitter: Follow us via @joegreeneov
Facebook: Search for OrthoVise or follow the link below and Like us. https://www.facebook.com/pages/OrthoVise/335420689882742
Linked in: Search company pages for OrthoVise, or follow the link  https://www.linkedin.com/company/orthovise?trk=biz-companies-cym

Wisconsin Payor Recognition

 

Full Recognition

Payors that formally recognize rehabilitation services delivered by athletic trainers.

  1. Anthem Blue Cross and Blue Shield of Wisconsin
  2. Dean Health Plan                                                   
  3. Unity Health Plan                                                  
  4. Physicians Plus Health Insurance
  5. Aurora BayCare (Self Insured Plan)
  6. FortCare Cerner (Self Insured Plan)
  7. Sysco (Self Insured Plan)

 

Reimbursement with Prior Authorization

These payors have recognized athletic training services when prior authorization has been secured.

Payment approval is inconsistent and denials are likely or common if you have not obtained prior authorization.

  1. Cigna
  2. Group Health Cooperative
  3. Health Partners
  4. Humana
  5. Medica
  6. United
  7. WEA
  8. WPS

 

Workers Compensation Payors

These payors are workers compensation payors that recognize and reimburse for outpatient rehabilitation services delivered by athletic trainers.

  1. Acuity
  2. America WC
  3. Amtrust North America
  4. Broadspire
  5. Chubb
  6. CBCS
  7. Hartland
  8. Horizon Management Group
  9. Liberty Mutual
  10. Preferred
  11. Secura
  12. Sedgwick
  13. Sentry
  14. State of Wisconsin
  15. Travelers Indemnity
  16. Travelers Property
  17. Tyson
  18. United Heartland
  19. United WI
  20. Wausau
  21. West Bend Mutual
  22. Western National WC
  23. WI State Historical Society
  24. Zurich American