An EDI business partner is any entity (provider, settlement service, clearinghouse, software provider, employer group, financial institution, etc.) that transfers or receives electronic data to another organization. Medicare FFS (Fee-ForService) and WPS Health Solutions support many types of business partners or customers for electronic data exchange (EDI). In order to ensure correct registration, it is important to understand the terminology attributed to each type of client. With your WPS Community Manager account, you can check the EDI transactions you transmit/receive with WPS. To set up an account in the WPS Community Manager, you must complete a first registration process and complete the required application forms and business agreements. To submit TRICARE For Life claims on the supplier TRICARE4U.com portal: to submit TRICARE East claims on the Humana Military Secured Provider portal, you must be registered with HumanaMilitary.com (go to Provider > Resources > Self-Service). If you are a non-Medicare certified provider, you can continue to submit your claims electronically via our online application for online rights registration if you are logged into your account with www.tricare4u.com. Sign the contract electronically by entering your name and clicking “Signature Contract.” Qualified suppliers can view the status of claims and customer authorization. TRICARE East Region Online Claim Submissions No live application to WPS from current suppliers in triCARE`s Eastern Region are allowed until January 1, 2018. Tricare east providers can enter claims into the portal for transfer to WPS and view the transfer instructions. Save time and money by signing up for paperless electronic transactions. Business partners also use this link to add new business and transaction lines when they register a new supplier. Medicare asks all business partners to complete the EDI registration and sign an EDI registration form.
The EDI registration document designates the Medicare and/or CEDI provider as the agency that hires them for EDI and ensures agreement between the parties to implement standard guidelines and practices to ensure the safety and integrity of the information exchanged. The forms can be accessed via the WPS Community Manager. TriWest has partnered with Availity® to offer a simple and free way to submit your claims electronically. With Availity`s Basic Clearinghouse offer, you can make claims to your firm at no cost. Transfer Electronic Funds (EFT) is also available for TRICARE For Life. EFT replaces the paper cheques you currently receive for TRICARE For Life application payments. When you log in to the EFT, you must receive your explanation data (EOB) either via Electronic Remittance Advice (ERA) or via our TRICARE4u website, as your paper EOBs will be configured 45 days after efT activation. If you want to start using EFT, you need to fill out an online electronic form for efT with WPS. Once the completed contract form has been received, WPS completes the pre-note process with your bank to ensure an easy conversion to EFT for your office. WPS encourages your office to take advantage of the benefits of EFT. Additional registration is required to establish a link with Availity`s WPS commercial partner IDENTIFIANT prior to sending claims to Tricare East. You need to call him directly for help for this step.
WPS Health Solutions wants you to know that your TRICARE For Life rights can be transmitted directly to WPS electronically. While most TRICARE For Life rights are crossed electronically by Medicare, some are not, including situations such as the beneficiary who has a Medicare Advantage plan.