EDI Set-Up For WPS Trading Partners

EDI Set-UpEDI Set-Up for new direct submitters that will submit EDI claims directly to WPS state that they will need to complete a self-registration process on the WPS Community Manager System to prepare for 5010 testing and production claim submission. Internet Access is required for EDI Set-Up and electronic claims submission. As a reminder, providers that are currently enrolled to submit EDI transactions to Medicare will not have to re-sign an EDI Enrollment Form.

Under HIPAA, EDI applies to all covered entities transmitting the following administrative transactions: 837I and 837P, 835, 270/271, 276/277 and NCPDP. Medicare contractors and CEDI will also use the TA1, 999 and 277CA error handling transactions. Medicare requires that WPS Health Solutions furnish new providers/suppliers that request Medicare claim privileges information on EDI. Additionally, Medicare requires WPS Health Solutions to assess the capability of entities to submit data electronically, establish their qualifications and enroll and assign submitter EDI identification numbers to those approved to use EDI.

The EDI enrollment process for the Medicare beneficiary inquiry system (HETS 270/271) is currently a separate process. A provider must obtain an NPI and furnish that NPI to WPS Health Solutions prior to completion of an initial EDI Enrollment Agreement and issuance of an initial EDI number and password by that contractor. WPS Health Solutions is required to verify that NPI is on the NPI Crosswalk. If the NPI is not verified on the NPI Crosswalk, the EDI Enrollment Agreement is denied and the provider is encouraged to contact WPS Health Solutions Provider Enrollment department (for Medicare Part A andPart B providers) or the National Supplier Clearinghouse (for DME suppliers) to resolve the issue. Once the NPI is properly verified, the provider can reapply the EDI Enrollment Agreement. A provider’s EDI number and password serve as a provider’s electronic signature and the provider would be liable if any entity with which the provider improperly shared the ID and password performed an illegal action while using that ID and password. A provider’s EDI access number and password are not part of the capital property of the provider’s operation, and may not be given to a new owner of the provider’s operation. A new owner must obtain their own EDI access number and password.

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