Electronic Media Claims for new east region

Electronic Data Interface

Information and timeline for TRICARE provider applications for electronic claims submissions

Humana Military was awarded the new East Region contract for TRICARE with an effective date of January 1, 2018. Wisconsin Physicians Services (WPS) will be the new fiscal intermediary/claims processor for TRICARE in the new East Region. The new East Region is a merger of the existing TRICARE North and TRICARE South Regions, which includes the following states: Alabama, Arkansas, Connecticut, Delaware, the District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa (Rock Island area), Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri (St. Louis area), New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Texas (excluding El Paso area), Vermont, Virginia, West Virginia and Wisconsin.

The transition of provider electronic claims processes, including electronic media claims (EMC), electronic funds transfers (EFT) and electronic remittance advice (ERA), to Wisconsin Physicians Service (WPS) for the new East Region, is underway to ensure all providers are ready for the start of healthcare delivery on or about January 1, 2018.

This page offers provider information on trading partner agreements, EDI/EMC applications and EFT/ERA processes for all providers submitting TRICARE claims electronically. Providers are expected to enroll anew for EMC, ERA, and EFT through WPS. Electronic interface with the current fiscal intermediary/claims processor will not transfer.

Jointly, Humana Military and WPS will make every effort to assist providers in a smooth transition of claims processing. The following is a full explanation of the provider registration process for EDI/EMC that will be made available starting April, 2017.

Alternate online claims entry portal

  • The Humana Military secured provider portal will also offer an online claims entry option that will allow TRICARE East providers to enter and submit claims. More information will be provided when the online option becomes available.
Please note: No LIVE claims submissions to WPS from current TRICARE providers are allowed until January 1, 2018. This early EDI/EMC campaign is to ensure providers are ready. 
  

EDI set-up with WPS

WPS requires that all electronic providers/groups sign, and have on file, a Trading Partner Claims Agreement (“Agreement”) prior to submission of electronic claims.

All providers that will submit EDI claims directly to WPS will need to complete a self-registration process that includes an initial registration and the necessary request forms and business agreement(s).

Begin the registration process

 

Request form and business agreement overview

Depending on your submitter type, you will need to complete request forms and business agreements after you have registered. They include:

  • Trading partner/submitter ID enrollment information form
Connectivity agreement (Required for ALL trading partners)
             Clearinghouse agreement (Required ONLY for clearinghouses)
  • Line of Business/Transaction (LOB/TXN) configuration edit form (used to setup the various lines of business and types of transactions each trading partner will be utilizing)
A separate LOB/TXN Configuration Edit Form is required for each line of business and transaction combination
  • Provider EDI Registration
Provider agreement (a separate agreement is required if registering for both Medicare and non-Medicare lines of business)
             Provider Electronic Remittance Advice (ERA) Agreement (optional)
Provider Electronic Funds Transfer (EFT) Agreement (optional)
  • Line of Business/Transaction (LOB/TXN) Production Approval Form (to be completed by direct submitters once a successful test file has been submitted)
A separate LOB/TXN Production Approval Form is required for each line of business and transaction combination

Please note: LOB/TXN Production Approval form is not required for ERA or EFT

  
ERA and EFT available

Electronic Remittance Advice (ERA) is an electronic version of your Explanation of Payment or Electronic Remittance (EOP) and allows you to automatically post your accounts.
  • If you currently receive ERA X12 835 files today, you will need to re-enroll through WPS Community Manager to receive ERAs from WPS.
Electronic Funds Transfer (EFT) is an electronic version of your paper check deposited directly into your checking or savings account.
  • If you currently receive claim payments through EFT you will need to re-enroll through WPS Community Manager to receive EFT payments from WPS.
Please note: You will be notified when you can complete registration for ERA and EFT through WPS Community Manager.

  
PC-Ace Pro32 software users

If you are currently using PC Ace software to submit your claims, you will need to upgrade to the current version of PC ACE. If you do not use PC ACE and would like to, please download our new WPS version.

  
The new TRICARE East Region payer ID is TREST. It will need to be placed in the following data elements within your X12 837 claim files:

  • ISA-08
  • GS-03
  • NM1-09 (with 40 qualifier)
We also encourage you to contact your clearinghouse, billing service, or software vendor to discuss transition-related issues.

A submitter (or trading partner) is someone who sends and receives electronic files. A submitter may be a provider and/or a clearinghouse.

How to contact the EDI team at WPS

We look forward to a successful relationship with our TRICARE East Region providers. If you have any questions or concerns regarding your claims transition, please contact us at:

EDI helpdesk team 1.800.782.2680 (option 1)
EDI marketing team 1.800.782.2680 (option 2)
Fax 1.608.223.3824
Email edi@wpsic.com