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Veteran’s Affairs Patient-Centered Community Care (VAPC3)

WPS Health Solutions is the subcontractor to TriWest Healthcare Alliance for Veterans Administration (VA) contracts including VAPC3 Regions 3, 5, and 6. The VAPC3 contract enhances access to health care services for Veterans by making a quality provider network available close to the Veteran's home. This contract ensures Veterans receive coordinated, high quality care in their community when VA refers behavioral health and specialty care to the network. These regions cover all portions of 28 states, broken down as follows:

  • Region 3: Alabama, Arkansas, Florida, Illinois, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, Tennessee, Texas, Virginia and West Virginia
  • Region 5A: Arizona, California, Colorado, Idaho, Nevada, New Mexico, Oregon, West Texas and Washington
  • Region 5B: Hawaii, American Samoa, Guam and the Northern Mariana Islands
  • Region 6: Alaska

These contracts serve the health care needs of nearly half of the eligible veterans in the country.

Claims

Your VA claims can be submitted electronically. 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 transactions are available electronically at the ASCX12 website.

For detailed reimbursement or claims questions, please contact 1-855-PCCCVET (722-2838). Choose Option 3 as a provider and then Option 3 to speak to a representative.

EDI Set-up with WPS

Getting Started

Note: If your office submits EDI claims through a clearinghouse, they may already be an approved clearinghouse with WPS. VAPC3 EDI Connection

New VA Receiver IDs (Payer IDs) and Other Important X12 837 Data Elements – Please refer to the Companion Guides.

Electronic Funds Transfer (EFT)

Electronic Funds Transfer (EFT) is available for VA providers. EFT replaces the paper checks you currently receive for claim payments. This process allows your payment to be deposited directly into your checking or savings account, and eliminates the delay or inconsistencies you may encounter with mail procedures.

EFT payments are typically deposited into your specified bank account two business days following the budget approval. Electronic Funds Transfer payments have a different number sequence than your current paper checks.

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. If you currently use more than one legacy provider number or NPI there will be more than one EFT transaction per day.

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. To enroll for EFT, go to our Enrollments page.

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 go to our Enrollments page.

To receive Electronic Remittance Advice (ERA) through a clearinghouse, go to our Enrollments page.

How to Contact the EDI Team at WPS

We look forward to developing successful relationships with our trading partners. If you have any questions or concerns regarding EDI transition to the new VA contracts for VAPC3 Regions 3, 5, and 6, please contact us at:

Wisconsin Physicians Service

Electronic Data Services
P.O. Box 8128
1717 W. Broadway
Madison, WI 53713

Fax: (608) 223-3824
Phone:(800) 782-2680 option 1

For further updates visit our website at www.wpsic.com/edi. We also encourage you to contact your clearinghouse, billing service, or software vendor to discuss transition related issues.