Providers may submit their files through: The WPS Bulletin Board System (BBS) IVANS VisionShare All 837Direct clients will be able to submit EDI Electronic medical bills directly to WPS using one of the three submission modes.
Full Answer
Do you provide EDI services for WPS Health Insurance?
We provide EDI services to our Trading Partners for WPS Health Insurance, TRICARE East Region, TRICARE Overseas, TRICARE For Life, Medicare MAC J5 Parts A and B, MAC J8 Parts A and B, and WPS Health Plan contracts.
How do I submit my test file to WPS?
Once you have created your test file, you submit it through your Gateway Express account. Once you have submitted your test file and you are ready for WPS to review it, go to our Enrollments page to submit a request for us to read and approve your file.
Where do I Send my Medicare claim?
The address for where to send your claim can be found in 2 places: On the second page of the instructions for the type of claim you’re filing (listed above under "How do I file a claim?"). On your "Medicare Summary Notice" (MSN).
How do I get Medicare to give my personal health information?
You need to fill out an " Authorization to Disclose Personal Health Information " if you want someone to be able to call 1-800-MEDICARE on your behalf or you want Medicare to give your personal information to someone other than you. Get this form in Spanish. Find out who to call about Medicare options, claims and more.
How to submit medical records to the WPS?
The best way to submit medical records is via the portal. You can find instruction for submitting documentation for an ADR request in the WPS Government Health Administrators Portal User Manual.
What to do if your fax machine cannot transmit all of your documents?
If your fax machine cannot transmit all of your documentation in one transmission, please use an alternate method to submit your documentation. (i.e., WPS GHA portal, hardcopy, esMD, etc.)
How to respond to ADR request?
Providers have two options for responding to an ADR request by mail: mailing hardcopy paper documentation or mailing documentation on CD/DVD. To ensure we can process your documentation, follow the applicable instructions below.
How to view ADR letter?
To view ADR letters, log into your WPS GHA portal account and select Letter Search (ADR Letter). The NPI will default to the primary NPI on the account.
What is a medical review calculator?
The Medical Review Calculator is available to assist providers in determining the final date the documentation must be received.
Is CPT copyrighted?
End User Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).
Can you send an ADR letter on a CD?
Do not send paper correspondence. You may submit responses to more than one ADR letter on a single CD. Each ADR response on the CD must be a separate, complete file. Begin Image file names with appropriate identification number (s), such as the Medicare Number and claim number.
How to submit Medicare claims electronically?
How to Submit Claims: Claims may be electronically submitted to a Medicare Administrative Contractor (MAC) from a provider using a computer with software that meets electronic filing requirements as established by the HIPAA claim standard and by meeting CMS requirements contained in the provider enrollment & certification category area of this web site and the EDI Enrollment page in this section of the web site. Providers that bill institutional claims are also permitted to submit claims electronically via direct data entry (DDE) screens.
What chapter is Medicare claim processing manual?
For more information please contact your local MAC or refer to the Medicare Claims Processing Manual (IOM Pub.100-04), Chapter 24.
What is EDI in Medicare?
EDI is the automated transfer of data in a specific format following specific data content rules between a health care provider and Medicare, or between Medicare and another health care plan. In some cases, that transfer may take place with the assistance of a clearinghouse or billing service that represents a provider of health care or another payer. EDI transactions are transferred via computer either to or from Medicare. Through use of EDI, both Medicare and health care providers can process transactions faster and at a lower cost.
What is the ASCA requirement for Medicare?
The Administrative Simplification Compliance Act (ASCA) requirement that claims be sent to Medicare electronically as a condition for payment; How you can obtain access to Medicare systems to submit or receive claim or beneficiary eligibility data electronically; and. EDI support furnished by Medicare contractors.
How to file a medical claim?
Follow the instructions for the type of claim you're filing (listed above under "How do I file a claim?"). Generally, you’ll need to submit these items: 1 The completed claim form (Patient Request for Medical Payment form (CMS-1490S) [PDF, 52KB]) 2 The itemized bill from your doctor, supplier, or other health care provider 3 A letter explaining in detail your reason for submitting the claim, like your provider or supplier isn’t able to file the claim, your provider or supplier refuses to file the claim, and/or your provider or supplier isn’t enrolled in Medicare 4 Any supporting documents related to your claim
What to call if you don't file a Medicare claim?
If they don't file a claim, call us at 1-800-MEDICARE (1-800-633-4227) . TTY: 1-877-486-2048. Ask for the exact time limit for filing a Medicare claim for the service or supply you got. If it's close to the end of the time limit and your doctor or supplier still hasn't filed the claim, you should file the claim.
How do I file a claim?
Fill out the claim form, called the Patient Request for Medical Payment form (CMS-1490S) [PDF, 52KB). You can also fill out the CMS-1490S claim form in Spanish.
What is an itemized bill?
The itemized bill from your doctor, supplier, or other health care provider. A letter explaining in detail your reason for submitting the claim, like your provider or supplier isn’t able to file the claim, your provider or supplier refuses to file the claim, and/or your provider or supplier isn’t enrolled in Medicare.
How long does it take for Medicare to pay?
Medicare claims must be filed no later than 12 months (or 1 full calendar year) after the date when the services were provided. If a claim isn't filed within this time limit, Medicare can't pay its share. For example, if you see your doctor on March 22, 2019, your doctor must file the Medicare claim for that visit no later than March 22, 2020.
When do you have to file Medicare claim for 2020?
For example, if you see your doctor on March 22, 2019, your doctor must file the Medicare claim for that visit no later than March 22, 2020. Check the "Medicare Summary Notice" (MSN) you get in the mail every 3 months, or log into your secure Medicare account to make sure claims are being filed in a timely way.
Does Medicare Advantage cover hospice?
Medicare Advantage Plans provide all of your Part A and Part B benefits, excluding hospice. Medicare Advantage Plans include: Most Medicare Advantage Plans offer prescription drug coverage. , these plans don’t have to file claims because Medicare pays these private insurance companies a set amount each month.
Which line does Medicare enter information on?
If Medicare is the secondary or tertiary payer, the provider identifies the primary payer on line A and enters Medicare information on line B or C as appropriate. Please see IOM Publication 100-05, Chapter 5 , section 30.5 for specific tertiary guidelines.
What is Medicare 31266?
31266 – An electronic Medicare secondary payer claim is submitted, and the value code amount is blank or zero and one following CAR C’s are present (see external narrative). Please correct if you can otherwise submit a new claim.
When does MSP stop?
The Disability provisions of MSP cease to apply as of the first day of the month the beneficiary turns age 65. See the CMS Medicare Secondary Payer Disability course page 5 for more information.
Can Medicare pay for MSP?
The intermediary's records indicate that the medical services and supplies provided to this beneficiary are covered by another primary payer insurance therefore, payment cannot be made under Medicare to the extent that services are covered by the primary insurance. Please bill the appropriate insurance plan and submit a MSP bill to Medicare upon receipt of the primary payment and/or denial.
Can you use CPT in Medicare?
You, your employees and agents are authorized to use CPT only as contained in the following authorized materials of Centers for Medicare and Medicaid Services (CMS) internally within your organization within the United States for the sole use by yourself, employees and agents. Use is limited to use in Medicare, Medicaid or other programs administered by CMS. You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.
Do you use D9 for MSP?
Do not use D9 other than for conditional payment. Please use appropriate MSP adjustment reason codes. Please see Medicare Secondary Payer (MSP) Codes for additional information.
Can a provider accept a primary payment?
Providers have failed to file a proper claim to the primary payer. Provider does not accept the primary payment as payment in full. Reminder: Providers are required to submit a covered claim for either determining the benefit period or for crediting the beneficiary’s Medicare deductible.
What is a CMS-1500?
The CMS-1500 claim form answers the needs of many insurers. It is the basic form prescribed by the Centers of Medica re & Medicaid Services ( CMS) for the Medicare program for claims from physicians and suppliers.
What is a Medigap policy?
Medigap: A Medigap policy meets the statutory definition of a "Medicare supplemental policy" contained in Section 1882 (g) (1) of Title XVIII of the Social Security Act and the definition contained in the NAIC Model Regulation, which is incorporated by reference to the statute.
Can you submit paper claims electronically?
Even if you qualify to submit paper claims, consider submitting electronically.
Do you list other supplemental coverage in item 9?
Do not list other supplemental coverage in Item 9 and its subdivisions at the time a Medicare claim is filed. Other supplemental claims are forwarded automatically to the private insurer if the private insurer contracts with the carrier to send Medicare claim information electronically.
