WPS Insurance Corporation - WPS Commercial Business and Epic Life Insurance

WPS has adopted a process to only reject claim submissions that are out of compliance with the ASC X12 version standard; the appropriate response for such errors will be returned on a TA1 Interchange Acknowledgement or a Implementation Acknowledgement. The implementation guide requires this segment if Loop is present. EDI User Guide for employer group trading partners. WPS will only accept claims for one line of business per transaction. Provider - An entity identified through NPI or Tax ID that performs a service and exchanges electronically via one or more external submitters. Specific information about the above-mentioned items can be found in the sections below Section 5.

WPS Trading Partner System Welcome to the WPS Trading Partner System (WTPS). WTPS is a web-based application that consolidates all of WPS trading partner information and provides a central location for adding and editing trading partner information.

Electronic Data Interchange (EDI) Terminology

We want to give each of you the time and guidance you deserve. And neither will you. This training course will discuss the basic principles behind polymer selection, deteriorative reactions in foods and shelf life. Run over 2 days, the course will provide attendees with the skills to link food chemistry, packaging design and polymer science. It will help them expand their knowledge base and competencies. Participants will be able to identify key packaging decision-making processes and validate their new knowledge to reframe package challenges and make successful food packaging decisions.

During this course, the attendees will have the opportunity to discuss their own real-life plastics packaging and shelf life experiences and examples. Providers must also not share their personal EDI access number with anyone on their own staff who does not need to see the data for completion of a valid electronic claim, to process a remittance advice for a claim, to verify beneficiary eligibility, or to determine the status of a claim.

No other non-staff individuals or entities may be permitted to use a provider s EDI number and password to access WPS systems. Clearinghouse and other third party representatives must obtain and use their own unique EDI access number and password provided by WPS. You are now ready to test. It is recommended that you submit a test file of at least twenty-five 25 claims that are applicable to your practice, so WPS can ensure your future production claims will process in an efficient manner.

It may not be necessary to submit this number if you are a smaller office who does not deal with a wide variety services. Once you have created your test file, you can submit through your chosen transmission method. There is no need to notify our office that you are sending a test file.

At that time we will approve your office for production submission or request that you make the necessary modifications to your data and submit another test file. Providers who use the correct password requirements will be approved. Testing and Certification Requirements 3. Test files must pass percent of the standard syntax edits before production submission is approved.

IG Semantic Data testing validates data required for claims processing.. Business edits are in place because of requirements in the WPS claim processing system. These data requirements are further data January 24,.

WPS will contact you with your test results within 3 business days of your test submission. Testing requirements have been met section 3.

The list can be found under the heading labeled EDI Connection towards the bottom of this web page. Vendors are only provided with testing capability. The following are some of the general system requirements for each. Re-transmission procedures If a claim file or claims within a claim file are rejected for whatever reason, you will need to resend the corrected file or create a new claim file with the corrected claims.

Users should take appropriate measures to prevent unauthorized disclosure or modification of assigned IDs and passwords. Violation of this policy will result in revocation of all methods of system access, including but not limited to EDI front-end access.

Intervals of when to change passwords are also described in these materials. Broadway, Madison, WI P. Box , Madison, WI Option 4 8: Box , Madison, WI Option 2 8: If transactions based on more than one TR3 Implementation Guide are being submitted, each must be contained within its own Interchange. Each interchange must have only one type of functional group within it. Version Notes and Business Edits 7.

Consequently, data later submitted for coordination of benefits will be submitted in upper case. You must submit incoming claim data using the basic character set as defined in the Implementation Guide. Submitting data not valid based on the Implementation Guides may cause files to be rejected. Non Implementation Guide data may not be sent for processing consideration. WPS will only accept claims for one line of business per transaction. Only valid qualifiers for WPS should be submitted on incoming claim transactions defined in the Business Edits below.

Use of qualifiers not defined by WPS may cause the claim or the transaction to be rejected. The subscriber may or may not be the same as the patient. Any Implementation Not Used data element which is received will be ignored and not be considered for processing. In order to assure proper adjudication of claims containing prior payer involvement, it is strongly recommended that WPS receive the prior payer information and a reason if there is no prior payment on the claim s submitted.

The following outline provides the basic elements of the which are needed for coordination of benefits claim processing. The loop is required when reporting other insurance, prior or otherwise. The multiple instances of SBR segments breakdown multiple payers and their adjudication information. The implementation guide requires this element if the claim was adjudicated by a prior payer. Loop and The CAS segments, as described in the implementation guides indicate the CAS usage to report prior payer adjustments that cause the amount paid to differ from the amount originally charged.

NM1 Other Subscriber s Name: The implementation guide requires this segment if Loop is present. NM1 Other Payer Name: The implementation guide requires when the line adjudication date is not used and the prior payer as adjudicated the claim.

WPS does not process non-adjunctive dental claims. Adjunctive dental claims must contain a diagnosis and be submitted in the Professional or Institutional format for adjudication by WPS. These requirements are defined in the Business Edits listed below. No foreign currency will be accepted.

Any information submitted in loop AC- Pay to Plan will be ignored and not considered in processing. More than two will be truncated CN1 05 Two decimal positions accepted.

Network Service Vendor NSV - An entity that provides secure connectivity services, but does not have access to content of the data being transmitted. Provider - An entity identified through NPI or Tax ID that performs a service and exchanges electronically via one or more external submitters.

An entity that owns the health care data being submitted. It is most likely the provider, hospital, clinic, etc. Provider Exempt Submitter - A submitter type that does not support a provider. This type of Submitter is not required to have Provider agreements signed in order to transact electronically or test the system.

Examples of Provider Exempt Submitters are vendors and third-party processors. Provider Exempt Transaction - Transaction that does not require provider agreements. These are transactions that do not have provider involvement. Examples of Provider Exempt transactions would be the and Submitter - Individual entity that sends or receives transactions defined by a unique identifier.

Initial person that registers the Corporation or Business and will be responsible for management of the account s including password resets for all users in their corporation.

Third-party processors may also price claims as a function of their role as a Provider Exempt Submitter. Trading Partner - Individual entity that sends or receives transactions defined by a unique identifier. Trading Partner Corporation - Corporation- or company-level entity that has one or more submitter that sends or receives transactions electronically defined by a unique identifier. Vendors submit for software testing purposes only.

Upcoming Short Course on Plastic Food Packaging & Shelf-Life

WPS is aware that some of our trading partners have intermittently received multiple claim acknowledgments (CA) for the same claim file. When multiple acknowledgments are received, one accurately displays accepted/rejected claims, and the others indicate the file is a duplicate. PS Trading Partner System (WTPS) is a web based application that consolidates all of WPS’ trading partner information and provides a central location for adding and editing trading partner information. Corporation - A corporation only has one WPS Community Manager trading partner account. Multiple Trading Partner IDs can be created within a corporation. Clearinghouse (CH) - An external submitter that sends and receives electronically for multiple providers. .