Provider Resources

WPS EDI Provider Resources


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WPS Health Plan, a subsidiary of WPS Health Insurance, is a fresh Wisconsin-based health insurer who strives to provide high-quality customer service, develop lifelong partnerships, and deliver cost-effective rates resulting in better coverage for our customers. We’re focused on new, innovative ideas that can make using health insurance more affordable and even easier for our customers to use.

WPS Health Plan offers a smart selection of individual health plans on and off the Health Insurance Marketplace, plus off-Marketplace group health plans. We value our local provider partnerships and appreciate your participation in northeast and north-central Wisconsin's premiere health plan.

Interested in becoming an electronic trading partner for WPS Health Plan claims? Visit Getting Started to begin the enrollment process today!

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The Health Insurance Portability and Accountability Act (HIPAA) requires health insurance payers in the United States to comply with the EDI standards for health care as established by the Secretary of Health and Human Services. The ANSI X12N 837 implementation guides have been established as the standard for compliance for claim transactions.

The implementation guides for the 837 professional and institutional are available electronically at ASCX12 website.

To submit WPS Health Insurance claims electronically to WPS you will need to complete registration through WPS Community Manager.


Electronic Funds Transfer (EFT):

Improve efficiency and go green with our EFT direct deposit service. When you use EFT, you no longer have to wait for paper checks to be delivered through the mail. Instead, your payment is deposited right into your checking or savings account. This environmentally responsible electronic process uses less paper.

Your Electronic Remittance Advice will be your office's notification of the payment that will be posted to your accounts. Notification of your payment into your accounts will come from your bank. Contact your bank for their notification procedures.

Electronic Remittance Advice (ERA):

The easiest way to receive your Provider Remittance Advice (PRA) is through ERA, which is an electronic version of a payment explanation. ERA is more convenient for you. When you sign up for EFT and ERA, you will find out about your payment via ERA about two days prior to the funds transfer. You can also request to suppress your paper PRAs for even further paper savings.

When you choose to receive Electronic Remittance Advice or ERA directly, your files will be sent to you in the X12 835 format, version 5010A1, and can be downloaded from our secured internet site WPS Gateway Express.

For enrollment to receive and download ERA (835) directly from WPS, you will need to first complete a registration through WPS Community Manager.


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