Providers

Find everything you need to serve and support your clients.

Welcome to your Family Care providers resource page.

We’re here for you and your team when you need us.

We are proud to help partners like you support local families. WPS is the Third-Party Administrator (TPA) for three Family Care MCOs: My Choice Wisconsin (MCWI), Inclusa and Lakeland Care Inc. (LCI). Our expert staff provides claims processing administration, contact center, reporting, provider outreach and other services.

Get easy access and fast answers with the WPS provider portal.

Ready to stay even more connected? The WPS provider portal is available for Family Care providers. Log in or register to get access to customer and/or participant information, authorizations, claims and secure messaging.

Family Care provider using the WPS provider portal on a laptop

If you’re already registered

Continue to access the provider portal to find what you need. If you also service Family Care members, 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.

Log in now →

If you have not registered

Complete the Request for Provider Access. Get started here.

Register now →

Attention: Important information for Family Care Providers.

As a reminder; all claims must be billed to WPS with the billing and servicing addresses as contracted by each Managed Care Organization (MCO). If the addresses do not align with the information provided by your Managed Care Organization (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 Managed Care Organization (MCO). If a Tax ID is submitted on a claim that is not contracted with your Managed Care Organization (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 or 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:

Go to portal

Submitting claims to Medicare?
Please read this.

The Centers for Medicare and Medicaid Services (CMS) has published final regulation requiring Family Care 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 that began October 1, 2020, for Family Care MCOs.

  1. Each Family Care MCO has agreed to be a COBA trading partner with CMS.
  2. Since 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 MCOs (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. Providers must continue to submit paper claims along with the paper EOMB to WPS in certain cases, such as:
    • The automatic crossover claim is denied by WPS and additional information is required to allow payment (such as Authorization number, 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 Insurance)
    • 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:”)

How this helps:

The COBA Medicare Crossover process is a value-added feature for Family Care providers. It speeds up payment and reduces provider administration costs. Questions? Call the WPS Family Care Contact Center: 1-800-223-6016.

Provider portal FAQs

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.

To register, click here.

To register for access to the provider portal, you need the following information from one of your remittances from the past 30 days:

  • Claim number
  • EFT/check number
  • Remittance date
  • Amount of the remittance

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.

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.

Wisconsin Family Care
c/o WPS—A health solutions company
P.O. Box 211595
Eagan, MN 55121
FAX: 608-327-6332 (do not include cover sheet)

Please refer to our list: WPS EDI Receiver and Payer ID Codes

  • Minimum of nine characters
  • Maximum of 20 characters
  • Must contain at least one uppercase character
  • Must contain at least one lowercase character
  • Must contain at least one number
  • Must contain at least one of the following special characters (no other special characters are allowed):
    • – (dash)
    • $ (dollar sign)
    • # (pound)
    • & (ampersand)
    • _ (underscore)
    • % (percent)
  • Please contact your MCO for authorization details
  • The Authorization/Referrals tab in the dashboard does not apply to Family Care providers
    • Please contact your MCO

Questions regarding member/participant eligibility need to be directed to your MCO.

How to go paperless and file claims electronically.

Save time, reduce costs and speed up your reimbursements. No matter which MCO you represent, our EDI staff wants to help you understand your electronic transaction options. Choose your organization below and don’t hesitate to call or email if you’d like us to match you to your best option.

My Choice Wisconsin

Lakeland Care

Inclusa

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.

Option 2: Register on WPS Community Manager (options 2)

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.

User Agreement

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.

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.

See FAQs Enroll in EFT/ERA

EFT and ERA 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.

Contact EDI staff

My Choice Wisconsin Resources

STEP 1: Choose your claim filing option:

Option 1: PC-ACE Pro 32

WPS offers and supports 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.

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.

User Agreement

STEP 2: Register on WPS Community Manager (options 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.

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.

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.

See FAQs Enroll in EFT/ERA

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.

Contact EDI staff

Lakeland Care, Inc Resources

STEP 1: Choose your claim filing option:

Option 1: PC-ACE Pro 32

WPS offers and supports 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.

STEP 2: Register on WPS Community Manager (options 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.

User Agreement

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.

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.

See FAQs Enroll in EFT/ERA

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.

Contact EDI staff

Inclusa Resources

Your all-in-one document center.

Family Care provider reviewing documents

How can we help?

Here’s a list of the Family Care documents available. Simply click on the document below to get started.

Family Care provider on the phone with WPS

If you don’t see the information you need, contact WPS

JO28472
38471-100-2604