MAC Jurisdiction 5 - Part A & Part B
Information
Important Notice
General Information
- Frequently Asked Questions
- Letter To Cahaba DDE Providers
- NPI 1500 Crosswalk
- Medicare Prepass Edits
-
Medicare Connection (Electronic Media Claims NPI approved Vendors, Billing Services and Clearinghouses)
Forms
- EDI Change of Submitter Form
- Electronic Funds Transfer Form
- Medicare EDI Provider Enrollment Form
- Authorization Form for Electronic Remittance Advice Processing (ERA)
- How to Complete a Medicare Electronic Remittance Advice (ERA) Authorization Form Tutorial (Power Point or Power Point Viewer Required)
- ERA - Deactivation Request Medicare Part A/B
- Professional Provider Telecommunication Network (PPTN) Access Request Form
Companion Documents
As of September 2007 WPS was selected as the Medicare Administrative Contractor (MAC) for Jurisdiction 5, which includes Parts A/B for the states of Iowa, Kansas, Missouri, and Nebraska.
Important notice: The WPS production cutoff time is 4 p.m. Central Standard Time. Claims received by 4 p.m. CST will be processed on the same business day.
Health Care Claim Status Request and Response
Wisconsin Physicians Service (WPS) has added a 276/277 (Health Care Claim Status Request and Response) request
form (PDF) to the EDI Forms Web Site.
- The 276 Transaction is an electronic request for the current status of a claim within the adjudication process. This can be requested at the claim and/or line level.
- The 277 Transaction is an electronic response to the 276 request.
This Transaction is a Batch process and requires the requester to have access to the Bulletin Board System. Request a Submitter ID. The Implementation Guide for this Transaction Set (276/277) is located at www.wpc-edi.com.
EDI Set-up with WPS
Providers that are currently enrolled to submit EDI transactions to Medicare will not have to re-sign an EDI Enrollment Form for MAC J5. The current Medicare contractor will provide WPS
with your existing Enrollment Form at the time of transition.
All providers, however, that will submit EDI claims directly to WPS will need to complete a self-registration process on our WPS Trading Partner System (WTPS) to prepare for transaction testing
and production claim submission. Click here to access the WPS Trading Partner System (WTPS)
If your office submits EDI claims through a clearinghouse, your clearinghouse will need to register on our WTPS application.
After registration has been completed on WTPS, we will send you the appropriate submitter ID and password information to connect to our WPS Bulletin Board System (BBS) through asynchronous telecommunications, along with our BBS user guide. If you use a clearinghouse, we will coordinate this information through your clearinghouse.
Providers without Internet access may register for EDI by contacting us at the telephone numbers indicated in the How to Contact the EDI Team at WPS section of this letter.
EDI Testing for MAC J5
Once your agreement is processed you will receive an EDI submitter number, password and either Bulletin Board System (BBS) instructions or Secure-EDI instructions based
on the submission method you chose. You are now ready to test. To prepare your test file, please refer to the appropriate WPS HIPAA Companion Document. 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), so we can ensure your future production claims will process
in an efficient manner. Once you have created your test file, you can submit through your chosen submission method. There is no need to notify our office that you are sending a test file.
When your test file has been submitted through either WPS Secure-EDI or the WPS Bulletin Board System (BBS) we will telephone or email your office with the results of your test and either approve claim files for production, or request that you make any necessary modifications to your data and submit another test file. We will make every effort to contact you with your test results within 2 – 3 business days of your submission.
The EDI Submission Process
When you establish connectivity to the WPS BBS with your submitter ID and password, and send an X12 837 claim file, you will receive an immediate acknowledgment that your file has been received together with an X12 997 transaction. Medicare’s EDI error report will be available for download from your BBS mailbox within one business day. We will provide you with a copy of the error report format when you receive your BBS submitter ID/password and user guide.
New MAC J5 Contractor IDs – Important X12 837 Data Element Change
CMS has assigned the following new contractor IDs for MAC J5 EDI claim submissions:
| State | Medicare Part A/B | MAC J5 Contractor ID |
| IA | Part A | 05101 |
| IA | Part B | 05102 |
| KS | Part A | 05201 |
| KS | Part B | 05202 |
| MO | Part A | 05301 |
| MO | Part B | 05302 |
| NE | Part A | 05401 |
| NE | Part B | 05402 |
- ISA-08
- GS-03
- NM1-09 (with 40 qualifier)
Trading partners that currently combine claims for multiple states within a claim file will need to create separate ISA – IEA segments for each state where services were rendered.
PC-Ace Software Users
PC-Ace Pro 32 V2.16 is now available online
If you currently utilize WPS’ version of PC-Ace Pro 32, effective October 16th, 2009 PC-Ace V2.16 is available for download. Download the new version.
If you are interested in becoming a new submitter for WPS please contact our EDI Help Desk at 1-866-503-9670 for assistance.
If you currently use PC-Ace software to submit your Medicare claims, you may continue to use your current PC-Ace version to send claims to WPS after transition, provided your PC-Ace version allows you to create additional submitter IDs. You will also need to establish connectivity with the WPS BBS as outlined in the EDI Setup with WPS section of this letter:
Other Important Transition Issues
Other important EDI-related items to note include:
- If you currently receive X12 835 electronic remittance files today, you will continue to receive these after transition. No further action is required.
- If you currently use MREP or PC-Print software to print Medicare X12 835 remittance files, you may continue to use this software after MAC J5 transition.
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If you currently submit X12 276 (claim status request) and receive X12 277 (claim status response) transactions, you will continue to receive these after transition. You will need to submit your X12 276
request files to the WPS BBS, and your response files will be placed in your BBS mailbox.
- If you currently receive claim payments through Electronic Funds Transfer (EFT), WPS will be sending you a new EFT enrollment form (CMS-588) to be completed and returned to our office prior to EFT setup. You will need to re-enroll prior to initiation of EFT for MAC J5 claim payments.
How to Contact the EDI Team at WPS
We look forward to continued successful relationships with our Medicare trading partners. If you have any questions or concerns regarding EDI transition to the new MAC J5, please contact us at:
- Part A EDI support: 1-866-503-9670
- Part B EDI support: 1-866-503-9670
Please note that for any MAC J5 Part A business that was previously supported by the Mutual of Omaha EDI team, you will continue to be supported by the same staff after transition as they are now a welcome addition to the WPS EDI team.
We also encourage you to contact your clearinghouse, billing service, or software vendor to discuss transition related issues. Please watch this Web site for additional transition information.
