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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.

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.

Your Electronic Remittance Advice will be your office's notification of the payment that will be posted to your accounts. Notification of your payment into your accounts will come from your bank. Contact your bank for their notification procedures. All you need to do to get started with EFT is complete the following form:
Provider Management of EFT Enrollment Form

Electronic Remittance Advice (ERA):

The easiest way to receive your Provider Remittance Advice (PRA) 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 directly, your files will be sent to you in the X12 835 format, version 5010A1, and can be downloaded from our secured internet site WPS Gateway Express.

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

To receive Electronic Remittance Advice (ERA) through a clearinghouse, complete the following:
Provider Management of ERA Enrollment Form