Medicare Part B Legacy EDI

WPS Insurance Corporation is the Medicare Part B Carrier for the states of Illinois, Michigan, Minnesota and Wisconsin.

The WPS production cutoff time is 4:00 p.m. Central Time. Claims received by 4:00 p.m. CT 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 to the EDI Forms website.

• 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 the Washington Publishing Company website.

Visit the Medicare Part B website

Claims

The Health Insurance Portability and Accountability Act (HIPAA) requires that health insurance payers in the United States, comply with the EDI standards for health care as established by the Secretary of Health and Human Services. The ANSI X12N 837 implementation guides have been established as the standard for compliance for claim transactions.

The implementation guides for the 837 professional and institutional are available electronically at the
Washington Publishing Company website.

Remittance

Electronic Remittance Advice (ERA) is an electronic version of your Explanation of Benefits and allows you to automatically post your accounts.

The implementation guide for the 835 is available at the Washington Publishing Company website.

Eligibility Request & Response Flat File Specs for Providers

The implementation guide for the eligibility 270/271 is available at the
Washington Publishing Company website.