EDI Security Protocols (WPS Health Solutions EDI Communication)
EDI Security Protocols policy strictly prohibits any trading partner from outsourcing system functions to any resource located outside of the United States or its territories. Prohibited outsourced functions include but are not limited to the transmission of electronic claims, receipt of remittance advice, or any system access to obtain beneficiary PHI and/or eligibility information.
Violation of this policy will result in revocation of all methods of system access, including but not limited to EDI front-end access or EDC RACF user access.
WPS Health Solutions is responsible for notifying all affected providers/suppliers as well as reporting the system revocation to CMS.
CMS’ information security policy strictly prohibits the sharing or loaning of Medicare assigned IDs and passwords. 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 or EDC RACF user access.
The submitter identifier or NPI constitutes the provider’s legal electronic signature and constitutes an assurance by the provider that services were performed as billed. Submitter shall use sufficient security procedures (including compliance with all provisions of the HIPAA security regulations) to ensure that all transmissions of documents are authorized and protect all beneficiary-specific data from improper access. Sharing of IDs and passwords is strictly prohibited and is a violation of CMS regulations. Submitter must be terminated when an ID is no longer needed.
TPs should protect password privacy by limiting knowledge of the password to key personnel, and all procedures that should be followed on password requirements, and intervals to change password, and when password should be changed when there are any personnel changes.
Only EDI Transactions submitted by authorized Trading Partners will be accepted. TPs shall protect password privacy by limiting knowledge of the password to key personnel, and all procedures that should be followed on password requirements, and intervals to change password, and when password should be changed when there are any personnel changes. Submitters/TPs can transmit via batch, 7 days per week, 24 hours per day.
WPS Health Solutions processes claims received before 4 pm CST each business day. Claims received after 4 pm CST will be processed on the next business day;