For faster claims processing, providers can now attach supporting documents when submitting electronic claims through self-service. We encourage providers to use the electronic claims process rather than using fax or secure messaging to submit additional documentation.
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.
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.
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).
Depending on your submitter type, you will need to complete request forms and business agreements after you have registered. They include:
Please note: LOB/TXN Production Approval form is not required for ERA or EFT.
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.
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
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.
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||(800) 782-2680 (option 1)|
|EDI marketing team||(800) 782-2680 (option 2)|