WPS Commercial Insurance, Family Care & HIRSP

Claims

The Health Insurance Portability and Accountability Act (HIPAA) requires that 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 on the
Washington Publishing Company website.

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

Remittance

Electronic Remittance Advice (ERA) is an electronic version of your Explanation of Benefits (EOB) and allows you to automatically post your accounts.

The implementation guide for the 835 is available on the Washington Publishing Company website.

Non-SSN Member Numbers to Be Assigned for Privacy Protection

To further enhance our information security, WPS Health Insurance will begin assigning non-SSN identification numbers beginning December 15, 2005.  These alternate numbers will be assigned to all new members and to our existing members upon request.

We will be able to cross-reference the non-SSN identification numbers with members' Social Security numbers as needed to ensure a smooth transition, with no claim delays or disruption in service.  Please submit claims with the identification number on the member's ID card.

We appreciate your cooperation in administering this change.  If you have any questions about this security enhancement, please contact Member Services toll-free at 1-800-223-6882.

Forms

• WPS Commercial Provider Authorization for ERA
• WPS Commercial EFT Agreement Instructions
• WPS Trading Partner Profile
• WPS Provider Agreement
• EPIC Provider Agreement
• Website User Agreement