Attention all Family Care providers
WPS is diligently working through claims that are currently pending for provider certification/enrollment review effective for dates of service 4/1/2026. We understand claims may be taking longer to process during this time and apologize for any inconvenience this may cause.
As a reminder; all claims must be billed to WPS with the billing and servicing addresses as contracted by each MCO. If the addresses do not align with the information provided by your MCO, WPS may return the claim unprocessed via a communication notice through the USPS.
In addition, providers must bill with the Tax ID that was used to enroll with DHS and is contracted with your MCO. If a Tax ID is submitted on a claim that is not contracted with your MCO or is not certified for the services being billed, the claim will be denied with denial reason code FBH.
Any corrections or inquiries related to your Wisconsin Medicaid enrollment should be handled through WI DHS/ForwardHealth prior to submitting claims by contacting the ForwardHealth Provider Service Call Center: 1-800-947-9627.
If you feel claims were denied incorrectly for WI Medicaid certification/enrollment, please contact the WPS Family Care Contact Center at 1-800-223-6016.
Find information and trainings about this requirement on the ForwardHealth Portal: forwardhealth.wi.gov/WIPortal/cms/public/ltc/provider_enrollment.htm
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.
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:
The WPS provider portal is available for Family Care providers. Register to obtain access to customer/participant information, authorizations, claims, and secure messaging.
In order to register, you are required to have the following:
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.
Two-Factor Authentication (2FA) has been added to your portal login. When you enter your username and password, you'll be asked to enter a one-time passcode (OTP) sent to your email. The OTP will be valid for 20 minutes, and once you are in the portal you will not need to enter a new OTP for the next 12 hours.
The provider portal provides access to:
NOTE: If you are a Family Care provider only, do not use the referrals, extras, and Find a Doctor links on your dashboard.
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.
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.
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
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.
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.
Change Healthcare's Payer Enrollment Services—FAQ
Enrollment questions?
Call Change Healthcare at 800-956-5190
Monday—Friday, 8 a.m. to 5 p.m. CT
Remember, we are here to assist you in any way we can to help transition you to an electronic cost-effective health insurance partner.
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.
800-782-2690, option 1
Email WPS
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
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.
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.
Change Healthcare's Payer Enrollment Services—FAQ
Enrollment questions?
Call Change Healthcare at 800-956-5190
Monday—Friday, 8 a.m. to 5 p.m. CT
Remember, we are here to assist you in any way we can to help transition you to an electronic cost-effective health insurance partner.
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.
800-782-2690, option 1
Email WPS
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
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.
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.
Change Healthcare's Payer Enrollment Services—FAQ
Enrollment questions?
Call Change Healthcare at 800-956-5190
Monday—Friday, 8 a.m. to 5 p.m. CT
Remember, we are here to assist you in any way we can to help transition you to an electronic cost-effective health insurance partner.