WPS Health Insurance

Getting Started with Electronic Claim Filing

1. Choose Your Claim Filing Option

Direct Filing

  • Vendor's software program A vendor provides hardware, software and/or ongoing support for total office automation or submission of electronic EDI transactions directly to individual providers, billing agents, or clearinghouses/VANs/NSVs. (Vendors submit for software-testing purposes only.)
  • PC-Ace Pro 32 software provided by WPS Health Solutions
  • Write your own program

Clearinghouse or billing service

The below EDI Connection links list contact information for all vendors, clearinghouses, and billing services that have been approved with electronic claim filing for:

2. Register for a Trading Partner Account in WPS Community Manager

Your WPS Community Manager account will allow you to verify the EDI transactions that you will submit/receive with WPS. In order for you to set up an account in WPS Community Manager, you will need to complete an initial registration process and complete the necessary request forms and business agreement(s).

To begin the registration process, please go to Enrollments.

3. Complete Testing

  • Once you have completed your initial enrollment and all required business agreements specific to your Trading Partner account, new WPS trading partners are required to submit successful test transactions in order to be approved for production. There is not a testing environment for 277, 835 or 270/271 (Real-Time transactions).
  • Once you have created your test file, you submit it through your Gateway Express account. Once you have submitted your test file and you are ready for WPS to review it go to our Enrollments page to submit a request for us to read and approve your file. If the file contains errors, we will provide you with the specific errors for you to correct and resend your test file.

Testing information

  • Must include 25 claims in your test file.
  • File must pass with 95% success
  • A separate test file for production approval is required for each line of business and transaction (837I or 837P) you will be submitting for.

*If you are using an approved clearinghouse or billing service, testing is not necessary.