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Important Notice

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MAC Jurisdiction 5 - Part A & Part B

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
WPS recommends that you conduct a test transaction unless you are already one of our established trading partners.

All testing will be completed using our EDI Testing Portal – our web-based, self- service testing solution which provides you with powerful problem identification and correction capabilities, and ensures transactions between trading partners are compliant.

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 (Western) Part B 05302
MO (Eastern) Part B 05392
NE Part A 05401
NE Part B 05402
The new contractor ID will need to be placed in the following data elements within your MAC J5 X12 837 claim files:
  • 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 V1.94 is now available online

If you currently utilize WPS’ version of PC-Ace Pro 32, effective February 15, 2008 PC-Ace V1.94 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.
  • 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.
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