Submit Medical Claims Directly to WPS

Medicare Part A Legacy (EDI) is moving from Mutual of Omaha to WPS Insurance Corporation EDI effective February 1, 2009.

Providers may submit their files through:

  • The WPS Bulletin Board System (BBS)
  • IVANS
  • VisionShare

All 837Direct clients will be able to submit EDI  Electronic medical bills directly to WPS using one of the three submission modes. Clients will need to complete a self-registration process on the WPS Trading Partner System (WTPS) to prepare for transaction testing and production medical claims submission. WTPS is located at the following URL:
https://corp-ws.wpsic.com/apps/wtps-web/unauth/wtps.do

After registration has been completed on WTPS, you will receive a 5 digit submitter ID and password to connect to WPS EDI.

You may begin submitting test medical claims to WPS EDI starting October 1, 2008, and begin submitting production files once approval is received.

Providers are encouraged to start testing now to avoid delays. Early testing may guarantee that your transition is completed prior to 2/1/2009.

For WPS EDI transition related questions please contact WPS at 1-866-734-6656 or you may contact us atSupport@medtrandirect.com

For additional details regarding this update visit:http://www.wpsmedicare.com/part_a/publications/edibbsmoving.shtml

C-SNAP Eligibility for Medical Claims

WPS has partnered with CMS to bring you this self-service web-site that will allow users to view eligibility and claim status information. On August 4, 2008, C-SNAP became available to all Part A and Part B J5 MAC providers. Legacy Providers are pending Part A access.

C-SNAP provides

National Eligibility Information

  • Medicare Part A and B deductible information
  • Medicare Secondary Payer (MSP) information
  • Medicare Advantage information
  • Hospice and Home Health Care information
  • Preventive Service information
  • Hospital Lifetime Reserve Remaining
  • Hospital Days Remaining
  • Hospital Coinsurance Days Remaining
  • Skilled Nursing Facility (SNF) Days Remaining
  • SNF Coinsurance Days Remaining
  • Part D Enrollment information
  • Part C Enrollment information

Claim Status Details

  • Reason/remark codes
  • Total paid amounts
  • Deductible amounts
  • Check Information
  • Claim numbers
  • Date processed
  • Procedure codes/modifiers billed
  • Total allowed amounts

Medicare Billing Reform

In 2003, CMS mandated a major change to the administration of Medicare fee-for-service (FFS) benefits. They achieved this with Medicare Contracting Reform, which is included in Section 911 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. The section requires HHS to replace the current contracting authority of Fiscal Intermediaries (Part A) and Carriers (Part B) with a new Medicare Administrator Contractor (MAC) authority. A Medicare Administrator Contractor (MAC) is responsible for the receipt, processing and payment of all Part A and Part B Medicare FFS claims. In addition to processing claims for payment, the MAC will be the primary contact for physicians and perform functions related to: Appeals, Provider Services, Financial Management, Provider Enrollment, Reimbursement, Payment Safeguards, and Information Systems Security. Continue reading