TRICARE provider tools

Electronic claims processes

Humana Military is the Managed Care Support Contractor (MCSC) for the TRICARE East Region, while Wisconsin Physicians Service (WPS) serves as Humana Military’s fiscal intermediary/claims processor for the new East Region.

Transition to Wisconsin Physicians Service (WPS)

With the start of the new TRICARE East Region contract, electronic claims will now be processed by WPS. The electronic interface with the former fiscal intermediary/claims processor did not transfer. As a result, providers will need to enroll for EMC, ERA and EFT through WPS in order to file electronic claims and receive payment for services performed after January 1, 2018.

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.


Alternate online claims entry portal

Humana Military's secure self-service portal offers a free online claims entry option that will allow TRICARE East providers to enter and submit primary and secondary claims.


EDI set-up with WPS

WPS requires all electronic providers/groups to 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