Provider Resources

Claims Editing Update

The facility edits will now be implemented as of Nov. 1, 2015. WPS Health Insurance will begin incorporating facility edits in our claims processing system. These edits are based on the Centers for Medicare & Medicaid Services (CMS) Correct Coding Initiative (CCI) sourcing.

You may view this information at the provider home page. On the site, please click on the green Go to My Account button and enter your user ID and password. Please click the tab entitled Claim Center. A drop down box will appear. From here, please click the box labeled CES (Claims Editing System).

Providers can proactively determine how particular code combinations will process. In addition, you may view and print the supporting rationale upon which an edit was developed.

Specific questions pertaining to CES should be directed to our Customer Service Department at 800-765-4977. 

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