Provider Resources

Family Care Groups



Family Care Groups


WPS is the Third-Party Administrator (TPA) for three Family Care Managed Care Organizations (MCO): My Choice Wisconsin (MCWI), Inclusa, and Lakeland Care Inc. (LCI). WPS provides claims processing administration, contact center, reporting, provider outreach, and other services.

To: Family Care providers who submit claims to Medicare:

Family Care to receive Coordination of Benefits Agreement (COBA) Medicare Part A and Medicare Part B Electronic Crossover Claims:

The Centers for Medicare and Medicaid Services (CMS) has published final regulation requiring Family Care managed care organizations (MCOs) to enter into a national Coordination of Benefits Agreement (COBA) for Medicare Part A and Medicare Part B crossover claims. CMS requires compliance with this regulation on October 1, 2020 for Family Care MCOs.

COBA Medicare Crossover Facts:

  1. Each Family Care MCO has agreed to be a COBA trading partner with CMS.

  2. On October 5, 2020 all Family Care MCOs’ member eligibility will be sent to CMS. CMS will then automatically send electronic claims, regardless of the date of service, to WPS for Medicare-enrolled members for Medicare-covered services.

  3. WPS will only accept and process Family Care covered services based on Family Care covered CPT-4, HCPCS and Revenue codes. Non Family Care covered codes will NOT be processed.

  4. The provider’s Medicare Remittance Advice will indicate that the claim was automatically crossed over to one of the Family Care MCO’s (indications such as “MA18” or Claim information forwarded to:). When the crossed over notice appears on the Medicare Remittance Advice, providers will NOT need to submit paper claims with the Medicare Explanation of Benefits (EOMB) to WPS.

  5. The following are cases when providers must continue to submit paper claims along with the paper EOMB to WPS:
    • The automatic crossover claim is denied by WPS and additional information is required to allow payment (such as Auth #, proper dates of service, service codes, etc.)
    • The claim is for a member who is enrolled in Medicare and has commercial health insurance which is secondary to Medicare (e.g., Medicare Supplemental)
    • The claim is for a member who was not enrolled in Family Care at the time the service was submitted to Medicare for payment, but the member was retroactively determined enrolled in Family Care
    • The claim is for a member who is enrolled in a Medicare Advantage Plan or Medicare Cost Plan
    • Medicare adjusted claim
    • WPS corrected claim form
    • When the Provider’s Medicare Remittance Advice does NOT indicate that the claim was crossed over (indications such as “MA18” or Claim information forwarded to: )
The COBA Medicare Crossover process is a value added feature for Family Care providers and will speed up payment and reduce provider administration costs. Please direct any questions to the WPS Family Care Contact Center phone number: 1-800-223-6016

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The WPS provider portal is available for Family Care providers. Register to obtain access to customer/participant information, authorizations, claims, and secure messaging.

  • Visit our Providers page, click the Register button and select WPS Health Insurance from the drop-down menu. Complete the Request for Provider Access in its entirety and click the Register button at the bottom.
  • Providers currently using the portal: Continue accessing the provider portal as you are now. However, if you also service Family Care customers, you will now be able to access their information using the provider portal. Please read on for important information about your account administrator and access privileges.

What do you need to register?

In order to register, you are required to have the following:

  • Two provider remittance advice (PRA) documents received within the last 90 days
  • One claim number from each PRA
  • Remit date and remit amount for each PRA
  • EFT/check number for each PRA

Are you a registering for the first time?

Important message for new providers: The first person to register under a tax ID will be the Administrator. This person will be required to invite and approve additional administrators and users under your organization’s tax ID. If you are not the first person at your site to register under a tax ID, you must wait for an invitation from the Administrator before registering as a user.

NOTE: If you have multiple tax IDs, you will need to register for the WPS provider portal under each tax ID.

What does the provider portal offer?

The provider portal provides access to:

  • Dashboard: View provider news and notifications.
  • Patient Search: Search patient information.
  • Authorizations: Search for authorizations and check authorization details.
  • Claims: Search for claims, check claims detail and corresponding Provider Remittance Advice (PRA), and submit claims electronically.
  • Secure Messages: View and send secure messages to the WPS Contact Center.
  • Profile Management: Change your security questions and password and set your preferences. Provider Administrators also can invite additional users under your organization’s tax ID and access the user signup queue to approve invitations
  • FAQs: Access frequently asked questions related to Family Care claims submission.

NOTE: If you are a Family Care provider only, do not use the referrals, extras, and Find a Doctor links on your dashboard.

 

My Choice logo

Electronic Claims Filing:

WPS Corporate Services-EDI would like to make sure you understand the available cost-effective options for electronic transactions. Taking the step to go paperless is an efficient way to reduce your costs and speed up your reimbursements. Your savings and satisfaction are important to us, so don’t hesitate to call or email if you would like to discuss your options. Our EDI staff is here to help you learn how to utilize electronic transactions, which will save you time and money in the process. Please choose your organization below to see your customized options.

Family Care-Managed Care Organizations (MCO)

Step 1: Choose your claim filing option

Option 1: MIDAS

My Choice Wisconsin requires, in most cases, contracted providers to use the provider portal. The provider portal, MIDAS (Member Information Documentation Authorization System), allows you to view your service authorizations, submit claims, and view claim status for My Choice Wisconsin members you serve.

877-489-3814
Email My Choice Wisconsin
My Choice Wisconsin MIDAS Portal

Option 2: Register on WPS Community Manager (Options 2 and 3 only)

This will register you in our system and assign you a WPS EDI Submitter ID to send claims directly to WPS.

*Note—If you are using an approved clearinghouse, you do not need to register for 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 eliminates the use of paper.

How to set up electronic funds transfer

Electronic Remittance Advice (ERA):

The quickest and most efficient way to receive your Provider Remittance Advice (PRAs) 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. Once you enroll for ERA we will suppress your paper PRAs for even further paper savings.

Remember, we are here to assist you in any way we can to help transition you to an electronic cost-effective health insurance partner.

Contact EDI staff

800-782-2680
Email EDI

My Choice Wisconsin Resources

My Choice Wisconsin 414-287-7600
My Choice Wisconsin Website
My Choice Wisconsin MIDAS Portal
Family Care Contact Center 800-223-6016
Email Family Care WPS
Lakeland Care, Inc. logo

Electronic Claims Filing:

Step 1: Choose your claim filing option

Option 1: PC-ACE Pro 32

WPS offers and supports this free software you can use to submit claims electronically. This software also provides an electronic process to receive claims status, perform eligibility searches, and view/print an Electronic Remittance Advice (ERA) in place of paper Provider Remittance Advice (PRA). Please call WPS EDI for more information on the initial setup of this option.

Option 2: Contact a clearinghouse or billing service to submit claims on your behalf.
If neither of these options will fit your needs, please contact us and we can discuss other options with you.

800-782-2680, option 1
Email WPS

Step 2: Register on WPS Community Manager (Option 1 and 2 only)

This will register you in our system and assign you a WPS EDI Submitter ID to send claims directly to WPS.

*Note—If you are using an approved clearinghouse, you do not need to register for WPS Community Manager.

Option 3: Spreadsheet Submission

This is a fast and easy way for providers to submit paperless claims. Must have access to and knowledge of Microsoft Excel or similar spreadsheet software


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 eliminates the use of paper.

How to set up electronic funds transfer

Electronic Remittance Advice (ERA):

The quickest and most efficient way to receive your Provider Remittance Advice (PRAs) 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. Once you enroll for ERA we will suppress your paper PRAs for even further paper savings.

Remember, we are here to assist you in any way we can to help transition you to an electronic cost-effective health insurance partner.

Contact EDI staff

800-782-2680
Email EDI

Lakeland Care, Inc. Resources

920-906-5100
Lakeland Care, Inc. Website
LCI DATACLARITY Portal
Family Care Contact Center 800-223-6016
Email Family Care WPS
inclusa logo

Electronic Claims Filing:

Step 1: Choose your claim filing option

Option 1: PC-ACE Pro 32

WPS offers and supports this free software you can use to submit claims electronically. This software also provides an electronic process to receive claims status, perform eligibility searches, and view/print an Electronic Remittance Advice (ERA) in place of paper Provider Remittance Advice (PRA). Please call WPS EDI for more information on the initial setup of this option.

Option 2: Contact a clearinghouse or billing service to submit claims on your behalf.
If neither of these options will fit your needs, please contact us and we can discuss other options with you.

800-782-2680, option 1
Email WPS

Step 2: Register on WPS Community Manager (Option 1 and 2 only)

This will register you in our system and assign you a WPS EDI Submitter ID to send claims directly to WPS.

*Note—If you are using an approved clearinghouse, you do not need to register for WPS Community Manager.

Option 3: Spreadsheet Submission

This is a fast and easy way for providers to submit paperless claims. Must have access to and knowledge of Microsoft Excel or similar spreadsheet software


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 eliminates the use of paper.

How to set up electronic funds transfer

Electronic Remittance Advice (ERA):

The quickest and most efficient way to receive your Provider Remittance Advice (PRAs) 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. Once you enroll for ERA we will suppress your paper PRAs for even further paper savings.

Remember, we are here to assist you in any way we can to help transition you to an electronic cost-effective health insurance partner.

Contact EDI staff

800-782-2680
Email EDI

Inclusa Resources

888-544-9353
Inclusa Website
Family Care Contact Center 800-223-6016
Email Family Care

The objective of these webcasts is to provide an overview of the following key informational subjects:

  • Required claims data elements when submitting claims to WPS
  • Claim submission options (electronic or paper)
  • Corrected claim procedures
  • WPS contact information
Family Care Claim Processing

   

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