WPS Needs Your Assistance...
WPS Military and Veterans Health is required to conduct quarterly focused reviews of a sample of medical records to assure that reimbursed services are supported by documentation in the patient's medical records.
The review will determine if the diagnostic and procedural information and discharge status of the patient as reported by the hospital is supported by the medical records.
You can assist us with this process by responding promptly to requests for documentation. WPS cannot validate the admission without records.
We appreciate your support and look forward to your cooperation in making the review process a success.
OHI (Other Health Insurance) Verification
Whether submitting claims through your office or submitting through a clearing house, it is imperative that you confirm the validity of your patient's OHI prior to sending in the claim. Duplicate claim submissions could also add incorrect OHI information to the patient's file. Invalid OHI and duplicate claim submission could delay processing, therefore slowing payment to your office.
How to use a Military ID for TRICARE insurance purposes...
A beneficiary’s Military ID card should be used as the TRICARE For Life benefit card. The Military ID is considered an insurance card and has all of the information that providers will need to file a claim.
The DoD number, benefits number or sponsor's social security number can be used when a policy number is requested.
Providers - Proper Billing...
When filing a claim for a TRICARE beneficiary, please make sure that the claim is filed for the entire billed amount and not just the Medicare deductible or coinsurance amounts.
Following these guidelines will facilitate a swift completion of your claims.
Beginning April 20th, information such as claims status, benefits and eligibility will be primarily supported through our web site and 800 line...
We’re excited to announce an extended list of options will be added to our call menu effective April 20th. These additional options will offer you and your office more comprehensive assistance and quickly and efficiently deliver answers for most types of information requests.
Our updated menu will include:
- Additional Claims Information
- Mental Health
- Substance Abuse
- Skilled Nursing Facility
- General Benefits
- Mental Health
- Chiropractic Care
- Eye Exams
- Hearing Aids
- Shingles Vaccines
- Eligibility - additional details and automatic call transfer to the appropriate, eligible region for the beneficiary will be made available.
- Frequently Asked Questions
We’re confident you will easily become proficient in collecting information from our intuitive, automated systems. The extended call menu will enable you to quickly get the answers you need.
Requesting EOB's (Explanation of Benefits)...
Beginning March 30, 2015, providers who are currently signed up for Electronic Funds Transfer (EFT), Electronic Remittance Advice (ERA) and/or paperless correspondence will no longer be able to request a paper Explanation of Benefits (EOB) by contacting a Customer Service Representative. To retrieve your duplicate EOB please sign on to the secured portion of this website and use the standard check claims status functionality.
Signing up for these options saves you time, money and paper, and are readily available to you 24 hours/7 days a week/ 365 days a year.
Preventing Duplicates on Medicare Crossover Claims...
When a patient has Medicare and TRICARE for Life coverage the provider of service only has to file with Medicare. Once Medicare has processed the claim it will be crossed over to TRICARE for Life. Medicare does not crossover claims for patients that have coverage in addition to Medicare and TRICARE for Life.
TRICARE for Life receives millions of claims from providers each month that have already been crossed over by Medicare. A duplicate claim is created when TRICARE for Life receives a Medicare crossover claim that the provider has also submitted. Not only are these duplicates costly for both the provider and TRICARE for Life but processing can be delayed because the claims may be held for review. Sending paper submissions or having your clearinghouse submit claims that are also electronically submitted may cause a delay in payment due to duplication.
Remember, it is easy to check claim status, just call our interactive voice information system at 1-866-773-0404 or log into the secured portal and choose view claims.
Routinely checking claim status for charges that are currently processing, or have been processed, should result in decreasing the number of duplicate submissions, making claims processing more efficient.
Requesting an Authorization for Adjunctive Dental Procedures...
To request authorization forms click on Forms in the left hand menu then click the "Service Request Notification for Authorization" under Authorizations. Please complete the form using the request instructions located on page three and send back to TRICARE for Life Authorizations.
The request form will be reviewed upon receipt to ensure that we have everything that we need to prove medical necessity (x-rays, medical history and treatment plan). A benefit decision will be made within five business days. After proof of medical necessity is approved, we will draft an authorization letter and fax/mail/secure email the decision. Read more....
Attention: TRICARE For Life Providers...
Do you want to save time, money, and paper with Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA)?
Interested? Complete our online form at: http://www.wpsic.com/edi/tools.shtml#eft-era.
Any questions, please contact us at 1-800-782-2680, option 4 or write us at WPS Electronic Data Services, P.O. Box 8128, Madison, WI 53708-8128 or email us at email@example.com
Thank you again for choosing WPS as your trusted health insurance partner.
TRICARE Set to Cover Laboratory Developed Tests...
Starting in September, TRICARE will cover certain laboratory developed tests (LDTs) under a new LDT Demonstration. The demonstration also allows TRICARE to cover approved laboratory developed tests retroactively if the coverage guidelines for the specific test are met.
Read the article: Military Health System and the Defense Health Agency website.
For more information about TRICARE coverage of LDTs, visit: TRICARE.mil.
Preventing Duplicate Claims - Procedure code G0283
Physical Therapy providers are required by Medicare to bill (unattended electrical stimulation) using procedure code G0283.
TRICARE accepts either code G0283 or 97014 for this procedure.
Most TFL claims, including procedure code G0283 are automatically crossed over from Medicare to TRICARE for processing therefore providers do not need to submit claims with procedure code 97014 directly to TRICARE. This will cause a duplicate claim.
When a claim is crossed over from Medicare, the EOB indicates "Claim forwarded to TRICARE".
After receiving payment from Medicare please allow time for TRICARE to process the claim before directly submitting it.