WPS Health Insurance

Getting Started with Electronic Claim Filing

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
  • Online claim entry (for TRICARE For Life Direct, Non-certified Medicare and Overseas ONLY)
  • 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:

Register for a Trading Partner Account in WPS Community Manager

Your WPS Community Manager account will allow you to establish a trading partner ID and 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 click on the following link: Community Manager
Once you have completed the initial registration process, you will receive a series of emails that will guide you through the process of completing the required request forms and business agreements specific to your Trading Partner account.

Complete Testing

Once you have completed your registration and all required request forms and business agreements specific to your Trading Partner account, you will be ready to test. In order to be approved to send production files, you will need to submit a test file of at least twenty-five (25) claims that are applicable to your practice (i.e., office visits, X-rays, lab work). This will ensure your future production claims will process in an efficient manner.

Once you have created your test file, you can submit it through your Gateway Express account. Once you have submitted your test file and you are ready for WPS to review it, you will need to complete a Line of Business/Transaction (LOB/TXN) Production Approval request. You will receive the link to the LOB/TXN Production Approval request form in an email upon completion of the LOB/TXN Configuration Edit form.

After you have submitted your LOB/TXN Production Approval request, we will respond via email indicating whether you are approved for production or if your test file contains any errors. If the file does contain errors, we will provide you with the specific errors for you to correct and resend your test file.

Note: You will need to send a separate test file and complete a separate LOB/TXN Production Approval request for each line of business that you will be submitting.

*If you are using an approved clearinghouse or billing service, then you will not need to complete any testing.