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EDI

Claims

The Health Insurance Portability and Accountability Act (HIPAA) requires health insurance payers in the United States, 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.

The NCPDP Telecommunication Standard Version 5.1 and Batch Standard Version 1.0 guides have been named for pharmacy claims.

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

Getting Started

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.

The number of EFT transactions initiated by WPS is dependent on the number of bank accounts to which your office requires EFT payments to be posted.

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

Click here to enroll for Electronic Funds Transfer (EFT).

Electronic Remittance Advice (ERA):

The easiest way to receive your 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. You can also request to suppress your paper PRAs for even further paper savings.

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

Click here to enroll to receive Electronic Remittance Advice (ERA) through a clearinghouse.

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