WPS EDI Trading Partner

WPS EDI Trading Partner Registration Basics And Terms

WPS EDI Trading Partner program is aimed to providing a single communication channel to ensure communication remains constant and efficient. WPS EDI Trading Partner program is focused on supplying the Trading Partner community with a variety of support tools. All Trading Partners are encouraged to visit WPS Health Solutions web site to ensure familiarity with the content of the site. WPS Health Solutions also distributes EDI pertinent information in the form of an EDI newsletter or comparable publication, which is posted to the website every 3 months. In addition to the website, a distribution list has been established in order to broadcast urgent messages.

An EDI Trading Partner is any entity (provider, billing service, clearinghouse, software vendor, employer group, financial institution, etc.) that transmits electronic data to or receives electronic data from another entity. Medicare FFS (Fee-ForService), and WPS Health Solutions support many different types of trading partners or customers for electronic data interchange (EDI). To ensure proper registration it is important to understand the terminology associated with each customer type.

A Submitter is the entity that owns the submitter ID associated with the healthcare data being submitted. It is most likely the provider, hospital, clinic, supplier, etc., but could also be a third party submitting on behalf of one of these entities. However, a submitter must be directly linked to each billing NPI. Often the terms submitter and trading partner are used interchangeably because a Trading Partner (TP) is defined as the entity engaged in the exchange or transmission of electronic transactions. Thus, the entity that is submitting electronic administrative transactions to WPS Health Solutions is a Medicare FFS trading partner. Provider/Supplier – the entity that renders services to beneficiaries and submits health care claims to Medicare. A Vendor is an entity that provides hardware, software and/or ongoing technical support for covered entities. In EDI, a vendor can be classified as a software vendor, billing or network service vendor or clearinghouse. Software Vendor – an entity that creates software used by billing services, clearinghouses and providers/suppliers to conduct the exchange of electronic transactions with Medicare FFS. Billing Service – a third party that prepares and/or submits claims for a provider/supplier. Clearinghouse – a third party that submits and/or exchanges electronic transactions (claims, claim status or eligibility inquiries, remittance advice, etc.) on behalf of a provider/supplier. Network Service Vendor – a third party that provides connectivity between a provider, supplier, clearing house or billing service and WPS Health Solutions.

Medicare requires all trading partners to complete EDI registration and sign an EDI Enrollment form. The EDI enrollment form designates the Medicare contractor and/or CEDI as the entity they agree to engage in for EDI and ensures agreement between parties to implement standard policies and practices to ensure the security and integrity of information exchanged. The forms can be accessed via the WPS Community Manager.

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