EDI Connectivity

EDI Connectivity Requirements: Process Flows And Transmission Procedures (WPS Health Solutions) EDI Connectivity ensures the integrity of the electronic transaction process. EDI Connectivity and the Trading Partner Agreement are related to the electronic exchange of information, whether the agreement is an entity or a part of a larger agreement, between each party to the agreement. Trading Partners Read More →

EDI Testing

 EDI Testing Requirements (Trading Partners) EDI Testing – WPS Health Solutions follows CMS testing requirements. Main requirements are the following: 25 claim minimum ISA14 Strongly encourage to use a 1 or a TA1 will not generate ISA15 must = T for testing 100% Syntax 95% Medicare business rules Submitter is considered in test until approved Read More →

EDI Academy

EDI Academy 2017 Results and 2018 Plans EDI Academy is one of the leading USA companies providing Electronic Data Interchange education in the USA and Canada. The previous year has proved this again – it was quite successful for our team. 24 regular trainings where conducted and our students learned basics of EDI, its role Read More →


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

EDI Set-Up

EDI Set-Up For WPS Trading Partners EDI 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 Read More →

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 Read More →

WPS Health Insurance

WPS Health Insurance EDI Overview and Advantages WPS Health Insurance EDI program encourages health care providers to file their claims electronically. The WPS Health Insurance EDI Corporate Services – EDI department – has a dedicated team whose primary function is to consult and serve providers regarding Electronic Data Interchange (EDI) issues. WPS Health Insurance EDI team is Read More →

270/271 Eligibility and Benefit Inquiry and Response

270/271 Eligibility and Benefit Inquiry and Response Transaction Guidelines 270/271 Eligibility and Benefit Inquiry and Response guidelines describe recommendations for HMSA partners involved in electronic documents transmission. The main requirements include the following: If multiple payers or multiple HMSA contracts cover a patient, the 271 response will contain multiple EB segments (where EB01 = “R” Read More →

Washington State Medicaid 270/271 HIPAA

Washington State Medicaid 270/271 HIPAA Transaction Notes Washington State Medicaid 270/271 HIPAA Transaction guidelines adopted under HIPAA clarify and specifiy the data content when exchanging electronically with Washington State Medicaid. When the trading partner submits the 270 request by any one of the specified methods the 270 request will be validated using EDI validator (up to Read More →

Washington State Health Care Authority

Washington State Health Care Authority EDI And Enrollment Requirements Washington State Health Care Authority EDI program works under general HIPAA standard requirements. Health Insurance Portability and Accountability Act (HIPAA) Electronic Data Interchange (EDI) is an electronic method of communicating standard transactions between covered entities (providers, clearinghouses and health plans). HIPAA EDI allows covered entities to submit Read More →