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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.

    Average processing time statistics for WPS Commercial claims:
      Electronic Claim Paper Claim
    HCFA-1500 5.2 days 13.3 days
    UB-92 6.5 days 12.29 days

  • Reduction of payment errors and data entry errors. As a result of WPS' pre-edits for EDI, claims which 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 them in beginning use of EDI transaction.
  • Lower administrative, postage and handling costs.
  • Availability of free software.
  • Availability of batch claims status inquiries.
  • The payment floor for Medicare Part B IL, MI, MN, WI claims is 14 days for electronic versus 30 for paper.
  • Faster claims processing. Providers who file claims electronically receive payment sooner than if they filed the same claim on paper.