WPS Health Insurance

EDI Overview and Advantages

EDI Overview

About

WPS Health Solutions has provided group and individual health insurance in Wisconsin for more than 70 years

The expertise that WPS developed over the years has enabled the company to be a successful provider of administrative services for the U.S. government. WPS Government Health Administrators (GHA) administers Part A and B benefits for millions of seniors in multiple states, and WPS Military and Veterans Health (MVH) serves millions of members of the U.S. military and their families. WPS has more than 40 years of experience in Electronic Data Interchange (EDI) processing.

Service

The WPS Corporate Services – EDI department has a dedicated team whose primary function is to consult and serve providers regarding Electronic Data Interchange (EDI) issues. Our team is experienced in dealing with a variety of provider specialties, billing services, and software vendors.

Providers who are interested in becoming an EDI Trading Partner with WPS should contact our EDI team.

EDI Advantages

Whenever possible, WPS encourages health care providers to file their claims electronically. Electronic filers receive these benefits:

  • Faster claims processing. Providers who file claims electronically receive payment sooner than if they filed the same claim on paper.
  • Reduction of payment errors and data entry errors. As a result of WPS' pre-edits for EDI, claims that pass to the processing system pend less frequently. This means less potential for processing errors.
  • Immediate verification of claims received. All of WPS' verification reports provide vital feedback at each stage of the EDI processing cycle. This feedback is not present with paper claim submission. After transmitting your claims to WPS, you receive a verification notice via e-mail indicating the number of claims and dollar amount we received. Also, an "Error Report" will be available the business day following your transmission. This report indicates whether any claims were submitted with errors and what changes need to be made for claims to be accepted for processing. These claims can be corrected and resubmitted electronically.
  • EDI program edits minimize the impact of data entry errors at your office by requiring certain information be entered on your claims.
  • The relative ease of use of EDI and the support available from the contractor to assist you in beginning use of EDI transactions.
  • Lower administrative, postage, and handling costs.
  • Availability of free software.
  • Availability of batch claims status inquiries.
  • The payment floor for Medicare claims is 14 days for electronic versus 30 for paper.