Checking for code edits has never been easier! WPS’ online code combination simulator, powered by CES (Clinical Editing Software), allows you to see how certain code edits will apply before you ever submit the claim.
Simply enter claim parameters such as CPT and ICD codes, modifiers, patient gender, etc. to view results and rationales that would apply to your claim. The tool is especially useful for identifying bundling/unbundling logic.
Access the code simulation tool on your WPS Provider Portal account home page. Don’t have a portal account? Registration is easy! Follow the instructions found on our website to get started today.
Not sure where to send your paper claims or send correspondence? All new paper claims, should be sent to the following claims filing address:
- WPS Health Insurance Claims
- PO Box 981641
- El Paso, TX 79998-1641
Do you need to send correspondence such as letters, corrected claims or medical records? Please send all correspondence to this address:
- Wisconsin Physicians Service
- PO Box 8190
- Madison, WI 53708-8190
HSM for Utilization Reviews
WPS has teamed up with HSM, Inc., to manage and streamline utilization management (UM) reviews. Some chiropractic and all rehabilitative therapy (PT/OT/ST) services are subject to HSM oversight in an effort to ensure services are delivered at the appropriate time and level of care.
Requests for rehabilitative and chiropractic services may be submitted to HSM via a link on the WPS iExchange login page. If you already have an account with HSM, you may use the same account to request services for WPS members. If you do not have an existing account, please contact HSM Provider Services at (800) 432-3640, option 3, for assistance.
To ensure timely claim processing, please pay close attention to your provider remittance advice (PRA) for informative explanation codes. If medical records are requested, please send them to:
- 7805 Hudson Rd, Suite 190
- St Paul, MN, 55125
- FAX: (888) 656-1913
Please do not send chiropractic or rehabilitative services medical records to WPS as this will delay the processing of your claims.