EDI Set-Up WPS Trading Partners (Using Third-Party Service)

EDI Set-Up WPSEDI Set-Up WPS Trading Partners requires Internet Aaccess for EDI Set-Up and electronic claims submission. If providers elect to submit/receive transactions electronically using a third party such as a billing agent, a clearinghouse or network services vendor, they are required to have an agreement signed by that third party. The third party must agree to meet the same EDI Set-Up WPS and Medicare security and privacy requirements that apply to the provider in regard to viewing or use of Medicare beneficiary data. These agreements are not to be submitted to Medicare, but are to be retained by the providers.

Providers will notify WPS Health Solutions which third party agents they will be using on their EDI Enrollment form. Third parties are required to register with WPS Health Solutions by completing the third party agreement form. This will insure that their connectivity is completed properly, however, a separate enrollment may be required for enrollment in mailing lists to receive all publications and email notifications. Providers must also be informed that they are not permitted to share their personal EDI access number and password with any billing agent, clearinghouse/network service vendor. 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 Medicare systems. Clearinghouse and other third party representatives must obtain and use their own unique EDI access number and password from WPS Health Solutions.

Medicare FFS (Fee-ForService) does not certify providers/suppliers, however, WPS Health Solutions does certify vendors, clearinghouses, and billing services in the form of testing with them and maintaining an approved vendor list.

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