WPS Health Insurance
Medicare

Please refer to the the WPS Medicare Part B website

 
TRICARE

Please refer to the provider page on TRICARE4U.com

 

Provider Portal Overview

Get quick, convenient access to member and claim information! Log in or register for a WPS Provider Portal account today! The portal is designed to provide real-time access to the following:

Go to My Account
 

Welcome Providers!

Wisconsin providers overlooking a daughter with her expectant mother

News

Where Can I Find Information on Medical Policy Updates?

As of this quarter, you may now access quarterly Medical Policy updates through your Provider Portal account, under the News section of the WPS Provider homepage Read More...

Where do I submit a paper claim?

If you previously submitted claims to PO Box 981641, El Paso, TX, please use the address below, effective Aug. 1, 2016, for all paper claims and claim related correspondence Read More...

Include a cover sheet for corrected claims

Effective Oct. 1, 2016, WPS asks that you include a cover sheet with any corrected claims you submit on paper Read More...

Revised Practitioner and Facilities Forms

We have recently revised the forms to be used when notifying WPS of practitioner or facility updates. Read More...

Useful Provider Information, Tools, and Resources

Online Code Combination Simulation Tools

Checking for code edits has never been easier! WPS’ online code combination simulator, powered by CES (Clinical Editing Software), allows you to see how certain code edits will apply before you ever submit the claim.

Simply enter claim parameters such as CPT and ICD codes, modifiers, patient gender, etc. to view results and rationales that would apply to your claim. The tool is especially useful for identifying bundling/unbundling logic.

Access the code simulation tool on your WPS Provider Portal account home page. Don’t have a portal account? Registration is easy! Follow the instructions found on our website to get started today.

WPS Claims Filing Address and Contact Information

Not sure where to send your paper claims or send correspondence? All new paper claims, should be sent to the following claims filing address:

  • WPS Health Insurance Claims
  • PO Box 21341
  • Eagan, MN 55121

Do you need to send correspondence such as letters, corrected claims or medical records? Please send all correspondence to this address:

  • Wisconsin Physicians Service
  • PO Box 8190
  • Madison, WI 53708-8190

HSM for Chiropractic and Rehabilitative Therapy Services

HSM for Utilization Reviews

WPS has teamed up with HSM, Inc., to manage and streamline utilization management (UM) reviews. Some chiropractic and all rehabilitative therapy (PT/OT/ST) services are subject to HSM oversight in an effort to ensure services are delivered at the appropriate time and level of care.

Requests for rehabilitative and chiropractic services may be submitted to HSM via a link on the WPS iExchange login page. If you already have an account with HSM, you may use the same account to request services for WPS members. If you do not have an existing account, please contact HSM Provider Services at (800) 432-3640, option 3, for assistance.

To ensure timely claim processing, please pay close attention to your provider remittance advice (PRA) for informative explanation codes. If medical records are requested, please send them to:

  • HSM
  • 7805 Hudson Rd, Suite 190
  • St Paul, MN, 55125
  • FAX: (888) 656-1913

Please do not send chiropractic or rehabilitative services medical records to WPS as this will delay the processing of your claims.

WI Autism Spectrum Disorder Mandate FAQ

Information and links to resources about Autism services.