This area of the HIRSP website is designed to assist providers with general information regarding HIRSP. If you are a member looking for a provider, please visit our provider and network page.
On Wednesday, May 15, 2013 the Wisconsin Legislature’s Joint Committee on Finance voted to include language in its proposed state budget that sunsets the Health Insurance Risk-Sharing Plan. The state budget must now pass the Wisconsin Assembly and Senate and be signed by Governor Walker. The language approved by the Joint Committee on Finance establishes the last day of coverage for HIRSP and HIRSP Federal Plan members as December 31, 2013 unless the federal healthcare marketplace in Wisconsin is not accepting applications at that time. The federal healthcare marketplace (formerly known as the healthcare exchange) is the key feature of national healthcare reform. The marketplace is expected to begin accepting applications on October 1, 2013 for private, guaranteed coverage effective January 1, 2014. HIRSP will be providing detailed information to HIRSP and HIRSP Federal Plan members in the near future. To stay informed, please register on the HIRSP website at http://hirsp.org/about/hcr-email-signup.php to receive important email updates regarding your HIRSP or HIRSP Federal Plan coverage. HIRSP and HIRSP Federal Plan coverage will remain in effect until December 31, 2013.
Health Insurance Risk Sharing Pool (HIRSP), will offset provider payments for unpaid refund requests. Providers will continue to be sent an initial request letter asking for payment to be made within 30 days. If there is no response, the next available HIRSP payment made to the provider will be ‘offset’. This includes both paper check and electronic payments.
The PRA – Provider Remittance Advice or ERN - Electronic Remittance Notice will contain information related to the customer for which the offset is being taken.
iEXCHANGE is a program offered by WPS Health Insurance that allows your clinical staff to submit prior approval requests for inpatient and outpatient services electronically to WPS using the Internet.
View the iExchange overview at
our Benefit Administrator's Website
(WPS Health Insurance)
HIRSP Federal Provider Rates
(The following page is located at the Forward Health Portal website.)
Visit Fee Schedules at Forward Health
HIRSP Provider Rates (Note: you will need to use a program that will read Microsoft
Excel documents to view these documents).
- Medical Policies
MedTrak Pharmacy Services
For formulary and pharmacy benefit information please visit the HIRSP Pharmacy
Benefit Administrator's site:
>> MedTrak Pharmacy