WPS Medicare EDI

WPS Medicare EDI Program Basic Overview

WPS Medicare EDI guidelines provide trading partners with the information they need to exchange EDI data with WPS Medicare. An Electronic Data Interchange (EDI) Trading Partner is defined as any Medicare customer (e.g., provider/supplier, billing service, clearinghouse or software vendor) that transmits to or receives electronic data from Medicare.

EDI addresses how providers/suppliers, or their business associates, exchange professional and institutional claims, claim acknowledgments, claim remittance advice, claim status inquiry and responses, and eligibility inquiry and responses electronically with Medicare. Guidelines also apply to electronic transactions that are being exchanged with Medicare by third parties, such as clearinghouses, billing services or network service vendors. Below is a listing of transactions required by WPS Medicare EDI program:

  • 270/ 271 Health Care Eligibility Benefit Inquiry and Response
  • 837 Health Care Claim: Professional
  • 837 Health Care Claim: Institutional
  • 999/TA1 Implementation Acknowledgment For Health Care Insurance
  • 835 Health Care Claim: Payment/Advice
  • 276/277 Status Inquiry and Response
  • 277CA Claim Acknowledgement
  • National Council for Prescription Drug Programs (NCPDP) Version D.0 of the Telecom Standard D.0 April 2009.

WPS Medicare EDI help desk is established for the first point of contact for basic information and troubleshooting. The help desk is available to support most EDI questions/incidents while at the same time being structured to triage each incident if more advanced research is needed. An EDI email is also accessible as a method of communicating with WPS Health Solutions the email account is monitored by knowledgeable staff ready to assist you. When communicating via email, please exclude any Protected Health Information (PHI) to ensure security is maintained. In addition to the WPS Health Solutions EDI help desk and email access, feel free to communicate via alternative methods.

WPS Health Solutions also has several external communication components in place to reach out to the trading partner community. WPS Health Solutions posts all critical updates, system issues and EDI specific billing material to their website.

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