Electronic Data Interchange (EDI) Overview

About

WPS Health Insurance (WPS) has provided group and individual health insurance in Wisconsin for over 50 years. WPS also processes Medicare Part B claims for the states of Wisconsin, Illinois and Minnesota, Part A and B claims for Iowa, Kansas, Missouri, Nebraska, Indiana, Michigan and J5 National Part A providers and serves as a sub-contractor to the Department of Defense's regional managed health care program TRICARE.

WPS has over 24 years of experience in Electronic Data Interchange (EDI) claims processing. We have accepted claims electronically in our claims division since:

• 1979 for our Medicare Part B operations
• 1990 for our TRICARE operations
• 1993 for our WPS Commercial operations
• 1996 for our EPIC Life Insurance Subsidiary operations
• 1997 for our self-funded operations
• 2007 for Medicare Part A and B operations (MAC J5 - Iowa, Kansas, Missouri, Nebraska, J5 National)
• 2012 for Medicare Part A and B operations (MAC J8 - Indiana and Michigan)

Future

The WPS Electronic Data Services department looks forward to an exciting and productive future. We anticipate a substantial increase in Electronic Commerce transactions with our trading partners, as more providers and billing vendors continue to upgrade their practice management systems to include these capabilities.

WPS has developed a system that allows EDI transactions over the Internet for WPS, EPIC, and TRICARE lines of business. We continue to offer and improve our superior EDI software products based on our trading partner's needs, as well as our supplemental EDI products such as WPS PLUS, Electronic Remittance Advice (ERA), and Electronic Funds Transfer.

We look forward to working closely with all of our trading partners to provide excellent EDI service and support today and into the future.

Service

The WPS Electronic Data Services department has a dedicated staff whose primary function is to consult and service providers regarding issues of Electronic Data Interchange (EDI). Our staff 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 call, for Medicare Part B toll-free 1-877-567-7261 or J5 National, Medicare MAC J and MAC J8 can call our EDI staff at 1-866-503-9670. For WPS Commercial and TRICARE contact our EDI Marketing staff at 1-800-782-2680, or contact us via our online form.

Successes

Corporately, we have over 5000 electronic submitters, representing clients, hospitals, pharmacies, and doctors in independent practice. In 2002, we received more than 87 million claims electronically for a corporate EDI percentage of 83.9%.