WPS Medicare Provider MAC Information - Self-Service

Frequently Asked Questions

Welcome to the WPS Medicare Frequently Asked Questions Web page.

WPS Medicare develops Frequently Asked Questions (FAQs) based on questions received in the contact center, written inquiries, and by other sources. The FAQs are designed to provide quick answers on hot topic questions received by the contractor.

Complex Issues

Contractor-designed FAQs on topic-specific complex issues are located on the specialty-specific pages of our Website. The answers to these complex questions can be found by viewing the following areas:

Please be sure to view the following implementation FAQs:

FAQs from the CMS Website

1. What company has been awarded the contract for the J5 A/B MAC workload?

2. What states are included in A/B MAC Jurisdiction 5?

3. What are the major contractual differences of the new A/B MACs compared to the current fiscal intermediaries (FIs) and carriers?

4. What is the effect of Medicare Contracting Reform on beneficiaries and providers?

5. What type of contract has been awarded for the J5 A/B MAC workload?

6. When will the new J5 A/B MAC begin operations?

7. What FIs and carriers are currently processing claims for the states in J5?

8. How will staffing be affected as work moves from the current FIs and carriers to the J5 A/B MAC?

9. How many beneficiaries and providers are there in J5? What percent of the national claims workload is accounted for in this Jurisdiction?

10. Did the winning contractor have any subcontracts? If so, what services will the subcontractor provide?

FAQs Answered by WPS Medicare

FAQs from the CMS Website

1. What company has been awarded the contract for the J5 A/B MAC workload?
Wisconsin Physicians Service Health Insurance Corporation (WPS) has been awarded the contract for the J5 A/B MAC.

2. What states are included in A/B MAC Jurisdiction 5?
The states included in Jurisdiction 5 are Iowa, Kansas, Missouri, and Nebraska.

3. What are the major contractual differences of the new A/B MACs compared to the current fiscal intermediaries (FIs) and carriers?
The workload for each new A/B MAC is being awarded through full and open competition conducted in accordance with the Federal Acquisition Regulation. Based on structured evaluation criteria, the proposal with the best value for the government will be selected in each procurement. The new A/B MAC contracts are for the administration of both Medicare Part A and Part B claims in a specific geographic jurisdiction. They allow for performance incentives to be earned by the MAC.

The FI and carrier contracts historically have been competed to a limited number of contractors which may or may not have been the best qualified organizations to do the work. In addition, the carriers have had to be chosen from health insurance companies. The contracts for the FIs and carriers do not allow for performance incentives; rather they pay the contractor the costs incurred in conducting their operations.

4. What is the effect of Medicare Contracting Reform on beneficiaries and providers?
Beneficiaries will have a single point-of-contact, connecting them to a seamless operations network for meeting their information needs. A beneficiary's first point of entry for resolution of questions about Medicare coverage will be 1-800-MEDICARE. The A/B MAC will handle only complex inquiries from beneficiaries.

The A/B MAC will serve as the point of contact for providers, physicians and practitioners for all claims-related business. Medicare contracting reform also will benefit providers with improved provider education and training by the A/B MACs.

5. What type of contract has been awarded for the J5 A/B MAC workload?
The J5 A/B MAC was awarded under a cost-plus-award-fee contract. The period of performance for the contract is a base period with four 1-year options. The total value of the contract for the five year period is approximately $225 million.

6. When will the new J5 A/B MAC begin operations?
The implementation activities of the A/B MAC that are needed to move the Part A/Part B workload for the states included in Jurisdiction 5 will begin immediately. The MAC will complete the transfer of the claims and information from FIs and carriers and be fully operational no later than September 9, 2008.

7. What FIs and carriers are currently processing claims for the states in J5?

Arkansas Blue Cross and Blue Shield (carrier for Eastern Missouri)
Blue Cross and Blue Shield of Alabama (FI for Iowa)
Blue Cross and Blue Shield of Kansas, Inc. (FI for Kansas; carrier for Kansas, Western Missouri, and Nebraska)
Blue Cross and Blue Shield of Mississippi (FI for Missouri)
Blue Cross and Blue Shield of Nebraska (FI for Nebraska)
Mutual of Omaha Insurance Company (FI for some providers in Iowa, Kansas, Missouri and Nebraska)
Noridian Mutual Insurance Company (carrier for Iowa)

8. How will staffing be affected as work moves from the current FIs and carriers to the J5 A/B MAC?
With the award and implementation of the new contract, one contractor will be performing the work that had been distributed among seven. Fewer staff will be required.

For more specific questions regarding staffing please contact the Contracting Officer, Darrell Bachman at Darrell.bachman@cms.hhs.gov or 410-786-8167.

9. How many beneficiaries and providers are there in J5? What percent of the national claims workload is accounted for in this Jurisdiction?
As of March 31, 2007, approximately 1,897,298 Medicare beneficiaries and 524 Medicare hospitals are located in the four states comprising this jurisdiction. Also, as of March 31, 2007, approximately 61,934 physicians and practitioners provided services in this area.

With respect to the workload, approximately 5.0% of Medicare fee-for-service claims nationwide is in this jurisdiction.

10. Did the winning contractor have any subcontracts? If so, what services will the subcontractor provide?
As the J5 A/B MAC, WPS is subcontracting with the following companies:

EDS which will supply Part B Medicare Business Systems (MBS)
Corporate Mutual of Omaha which will supply Part A print/mail services, Part A Data Center programming services, records storage and leased facility space.

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FAQs Answered by WPS Medicare

Claims Processing and Coverage

1. Will the coverage criteria change as a result of the transition?
The outgoing contractor will provide the MAC with any Local Coverage Determinations (LCDs), formerly known as Local Medical Review Policies (LMRPs). The MAC is required to consolidate the existing LCDs of the outgoing carriers/intermediaries within its jurisdiction so that they are the same throughout the jurisdiction. The consolidation must be completed prior to the cutover of the first segment within the jurisdiction.

2. Do you anticipate a claim-processing backlog?
WPS Medicare is confident that we will be able to transition the claims processing workload without any delays. Your claims will continue to be processed within the CMS approved time frames.

3. Does WPS use the same processing system as the previous contractors and Fiscal Intermediaries?
Yes, WPS uses the same processing systems as your previous contractors and Fiscal Intermediaries.

4. Will I continue to receive separate payments for Part A and Part B claims?
Yes, WPS will continue to make separate payments for Part A and Part B services.

5. Will the Provider Remittances look the same?
Yes. CMS' Multi Carrier System (MCS) processes your Part B claims currently. That will continue with WPS Medicare. Therefore, the remittance advice will have the same look and feel.

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Electronic Data Interchange (EDI)

1. How will I obtain a new electronic Payer ID before I start sending claims to you electronically?
WPS Medicare Electronic Data Interchange (EDI) department will soon send J5 providers a letter with information on connectivity, the Bulletin Board System (BBS), and Submitter IDs among other topics.

2. Do you participate with all the clearing houses? If not, can we have a list of who you do participate with?
We currently have a list of clearinghouses we participate with. However, we are updating that list, and it should be available shortly. Continue to check the Website for these updates. In addition, Listserv enrollees will be notified via e-mail. We encourage all J5 providers to enroll with the J5 transition Listserv. You may subscribe to the J5 Transition Listserv on our Website.

3. Do you have free billing software that allows us to submit claims electronically?
WPS Medicare does offer free billing software for providers to submit electronic claims and will continue to use this software in the future. The software is PC-Ace Pro32 and is available on our Website:
http://www.wpsmedicare.com

4. Will I need to complete a new EDI enrollment form for J5 MAC?
Providers that are currently enrolled to submit EDI transactions to Medicare will not have to re-sign an EDI Enrollment Form for J5 MAC. The current Medicare contractor will provide WPS with your existing Enrollment Form at the time of transition.

Providers that will submit EDI claims directly to WPS will need to complete a self-registration process on our WPS Trading Partner System (WTPS) to prepare for transaction testing and production claim submission. WTPS is located at the following URL:
https://corp-ws.wpsic.com/apps/wtps-web
/unauth/wtps.do

If your office submits EDI claims through a clearinghouse, your clearinghouse will need to register on our WTPS application.

After you complete registration on WTPS, we will send you the appropriate submitter ID and password information to connect to our WPS Bulletin Board System (BBS) through asynchronous telecommunications, along with our BBS user guide. If you use a clearinghouse, we will coordinate this information through your clearinghouse.

Providers without Internet access may register by contacting us at:
Part B EDI support: 800-782-2680
Part A EDI support: 866-734-6656

5. When will I begin submitting my claims to WPS Medicare?
All of your electronic transactions will be conducted with WPS Medicare beginning on the following specified transition date:

State	Transition Date
Nebraska Part A	12/1/2007
Iowa Part B	2/1/2008
Kansas Part A	3/1/2008
Missouri (Western) Part B, Kansas Part B,
Nebraska Part B	3/1/2008
Missouri Part A	5/1/2008
Iowa Part A	5/1/2008
Missouri (Eastern) Part B	6/1/2008

6. When can I begin submitting test transactions to WPS?
The target dates for our J5 MAC trading partners begin testing EDI transactions with are:

Kansas Part B

State	Transition Date	Recommended Test Start Date
Nebraska Part A	12/1/2007	11/15/2007
Iowa Part B	2/1/2008	11/30/2007
Kansas Part A,	3/1/2008	12/15/2007
Missouri (Western) Part B,
Nebraska Part B	3/1/2008	12/15/2007
Missouri Part A	5/1/2008	2/1/2008
Iowa Part A	5/1/2008	2/1/2008
Missouri (Eastern) Part B	6/1/2008	3/1/2008

7. What contractor ID will I use for J5 MAC EDI claims submissions?
CMS has assigned the following new contractor IDs for J5 MAC EDI claim submissions:

State	Medicare Part A/B	J5 MAC Contractor ID
IA	Part A	05101
IA	Part B	05102
KS	Part A	05201
KS	Part B	05202
MO	Part A	05301
MO (Western)	Part B	05302
MO (Eastern)	Part B	05392
NE	Part A	05401
NE	Part B	05402

Place the new contractor ID in the following data elements of your J5 MAC X12 837 claim files:

ISA-08
GS-03
NM1-09 (with 40 qualifier)

Trading partners that currently combine claims for multiple states within a claim file will need to create separate ISA - IEA segments for each state where services were rendered.

8. I use the PC-Ace software. Can I continue to use this software to submit my claims?
Yes. If you currently use PC-Ace software to submit your Medicare claims, you may continue to use your current PC-Ace version to send claims to WPS after transition. You will need to establish connectivity with the WPS BBS as outlined above.

WPS will implement a new version of PC-ACE sometime after transition has occurred. We will provide you with further information regarding the new version when it is ready for distribution.

9. How can I contact the EDI team at WPS?
If you have any questions or concerns regarding EDI transition to the new J5 MAC, please contact us at:

EDI Support: 866-503-9670

Please note that any J5 MAC Part A business previously supported by the Mutual of Omaha EDI team will continue to be supported by the same staff after transition as they are now a welcome addition to the WPS EDI team.

Please note that for any J5 MAC Part A business previously supported by the Mutual of Omaha EDI team will continue to be supported by the same staff after transition as they are now a welcome addition to the WPS EDI team.

10. How soon after a transaction can I expect an error report from WPS?
When you establish connectivity to the WPS BBS with your submitter ID and password, and send an X12 837 claim file, you will receive an immediate acknowledgment that your file has been received together with an X12 997 transaction. Medicare's EDI error report will be available for download from your BBS mailbox within one business day. We will provide you with a copy of the error report format when you receive your BBS submitter ID/password and user guide.

11. What forms do providers need to complete in order to receive reimbursement from WPS?
If you currently receive claim payments through Electronic Funds Transfer (EFT), WPS will send you a new EFT enrollment form (CMS-588) to complete and return to our office prior to EFT setup. You will need to re-enroll prior to initiation of EFT for J5 Mac claim payments.

12. How do I become a trading partner with WPS?
In order to submit EDI claims directly to WPS you will need to complete a self-registration process on our WPS Trading Partner System (WTPS) to prepare for transaction testing and production claim submission. WTPS is located at the following URL: https://corp-ws.wpsic.com/apps/wtps-web
/unauth/wtps.do . After registration has been completed on WTPS, we will send you the appropriate submitter ID and password information to connect to our WPS Bulletin Board System (BBS) through asynchronous telecommunications, along with our BBS user's guide.

13. Do I need to complete a new Electronic Remittance Advice (ERA) enrollment form for MAC J5?
WPS does have a form for requesting ERA set-up (this is called our ERA Input Form); however, if you are already receiving ERA from the outgoing contractor, you do not have to re-enroll with WPS. You will automatically continue to receive X12 835 files after MAC J5 transition. The ERAs you receive from WPS will contain your new EDI submitter number.

14. I do not have internet access. How do I register to become a WPS trading partner?
You may register by contacting us at: Part A EDI Support: 866-734-6656; Part B EDI Support: 800-782-2680.

15. Do providers need to get a different submitter ID for different divisions within a hospital?
No, a separate submitter number is not required for each division

16. What is the production cutoff time for my EMC submissions?
Production cutoff time is 4:00 p.m. CST. Transactions that complete after 4 pm CST and after are considered received the next business day.

17. We currently are a WPS trading partner for other lines of business. Do we need a different submitter ID?
No. If you are already an established trading partner, you may continue to use your existing WPS-assigned submitter ID for new MAC J5 provider transactions. WPS notified our established trading partners that we are implementing a new Bulletin Board System (BBS) to enhance the security and integrity of data transfers. All MAC J5 trading partners will need to send and receive files through our new BBS. User guides for the new BBS are available on the WPS EDI web site at: https://www.wpsic.com/edi/
edi_bbs.shtml .

18. We received a letter about testing with WPS. Who should we call if we have questions?
For EDI MAC J5 Part A: 866-734-6656; EDI MAC J5 Part B: 800-782-2680 (wait for a representative do not select Medicare B).

19. Can current trading partners, vendors and future vendors begin testing earlier than the "Recommended Test Start Date?"
In preparation for the J5 workload, WPS is working to establish connections with data centers. Submitters can test connectivity with the BBS in advance; however to be able to get test reports as part of your results, the recommended test date schedule applies.

20. When the new PC Ace is upgraded, will it include other lines of business?
WPS is working with the outgoing contractors and PC Ace vendor. We will provide additional communication in the near future.

21. If I am using PC-Ace software for both Part A and Part B, can I begin sending claims for both at the same time? Otherwise how do I separate Part A/B claims without major reformatting?
Providers can only submit claims to WPS based on the cutover date for their state (no earlier), and in some cases Parts A/B for a particular state do not transition at the same time. You will need to create a new payer ID within your PC-Ace software for WPS-Medicare Part A, and another for Part B. When the Part B cutover occurs, you will need to use the Part B payer ID to submit claims, and this same thing will occur with Part A. The WPS-assigned submitter number you receive when you register as a WPS trading partner should be used for both Parts A/B claim submissions.

WPS is currently working with the PC-Ace vendor and each of the outgoing contractors, and you will receive additional information regarding PC-Ace set up soon.

22. When testing, do I sign on using the same logon ID/password as production?
Yes, you do use the same logon ID/password.

23. After I send a test file, how will I be notified? Will I be contacted by phone or will I receive a generated report?
Test results will be returned to you in 2-3 business days via email, phone, or fax.

24. What indicator will I use in the ISA15 when testing?
The ISA15 can be set to T for test or P for production in test. Conversely, P is the only valid value if submitting production.

25. Are the test results based on percentage?
CMS guidelines require a submitter must submit at least 25 claims and have a minimum 95% accuracy rate in test data.

26. If I want to add new providers to my submitter ID, do I use the same forms that I previously used or are there new ones?
Providers currently enrolled as an electronic submitter (e.g. previously completed an EDI Enrollment) may fax changes to EDI.

27. Is WPS doing the translation of the Medicare Part A files?
No, Medicare Part A files go through the Med A translator product. WPS simply checks the file structure, responds with an X12 997, and forwards the file to the Part A systems.

28. How is the transition to the new claims system going to be handled? If the provider has claims on RTP (return to provider) will the providers be required to resubmit them to the new system? Will any claims (existing in the current claims system-FISS) have to be resubmitted once the transition to the new claims system-FISS?
WPS uses the same processing systems as your previous contractors. The Multi Carrier System (MCS) and Fiscal Intermediaries Shared System (FISS).

29. We are a current clearinghouse with WPS. Are there any "formal testing requirements" for the new J5 work?
Yes. Current trading partners must migrate to WPS' new Bulletin Board System (BBS) for MAC J5 claims submission. In order for you to receive access to send production claims through the new BBS, a test file must first be submitted.

30. We currently send our Medicare Part A claims to Mutual of Omaha, who is our selected Intermediary. How does the implementation of J5 affect our Medicare A claims to Mutual of Omaha?
Claims that are currently routed to Mutual of Omaha will continue to be sent to Mutual of Omaha; -- this is considered Mutual of Omaha legacy workload, and it doesn't transition to MAC J5 until sometime starting in mid-2009. WPS staff in Omaha are supporting the Mutual Medicare A legacy workload, the claims will not be sent to the WPS EDI front-end until mid-2009.

31. What is the cutoff time for those transitioning to J5 MAC to submit claims to the outgoing contractor?
For Iowa Part B, Noridian has indicated the latest time for submission is on 1/31/08 at 4:00 PM. Blue Cross Blue Shield of Kansas has indicated their cutoff time is 2/28/08 at 2:00 PM.

32. Can I send Medicare claims to WPS over the Internet?
CMS has not approved Internet submission of Medicare claims. You can submit claims via dial up modem directly to the WPS Bulletin Board System. You may also select a connectivity vendor, such as IVANS or VisionShare. Additional means to submit claims to WPS Medicare would be by a clearinghouse or a billing service.

33. I really enjoyed the recent EDI J5 MAC ACT. Will you host additional ACTs?
Because of the large demand, WPS will be adding additional EDI J5 ACT calls. All calls are from 1:00 - 3:00 PM CST. Dial in number for each is (877) 290-9695. Passcodes vary and are listed below.
2/13/08 24672665
2/27/08 31520987
3/12/08 24673114
3/26/08 31521861

34. I did not get a chance to ask my question during the recent EDI ACT. How can I contact EDI?
You can call the J5 EDI Hotline at (866) 503-9670 or send your inquiry to EDIMedicareA@wpsic.com or EDIMedicareB@wpsic.com

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Enrollment/Provider Identification Numbers

1. If I am currently enrolled as a participating physician with Medicare, am I going to have to re-enroll with WPS?
No. Your participation status and legacy provider number from the former contractor will be unchanged upon cutover to WPS Medicare.

2. Will I keep my current legacy provider number after we transition to WPS?
Yes. You will keep your legacy provider number, however WPS Medicare staff may refer to the number as a PTAN (Provider Transaction Access Number) for identification purposes.

3. If providers are now receiving EFT remittances, do they have to do anything to continue or will you have all that banking information from Noridian?
WPS Medicare will execute new EFT agreements with J5 providers. EDI is sending letters to J5 providers with information regarding the EFT agreements.

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General

1. Why is this transition taking place?
As required by section 911 of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003, the Centers for Medicare & Medicaid Services (CMS) is in the process of replacing its current claims payment contractors - fiscal intermediaries and carriers - with new contract entities called Medicare Administrative Contractors (MACs).

2. Once the transition occurs, will providers be contacting Noridian for anything, or do all inquiries go to WPS, even if it was an issue prior to transition?
All inquiries should come to WPS upon the transition date of your segment. These dates are available by clicking on this link .

3. Where will both Part A and Part B claims be processed after implementation?
The Part A claims will be processed in Omaha and the Part B claims will be processed in Madison, Wisconsin.

4. Who should we contact if we have questions?
If your question relates to the implementation, before cutover, located at http://www.wpsmedicare.com/mac
/index.shtml on the WPS Medicare Website is an e-mail address to submit your questions.

5. Will WPS Medicare have Part A and Part B Provider Outreach & Education Advisory Groups (POE AGs)?
Yes. WPS Medicare will have Jurisdiction 5 POE AGs. We will contact existing POE AG members to ascertain if they wish to remain POE AG members.

6. Will current J5 Carrier Advisory Committee (CAC) members continue in this role after implementation?
WPS Medicare has always had an excellent relationship with our CAC members. WPS Medicare is obtaining the current CAC membership rosters for each J5 state. We will be contacting each member throughout the implementation. We encourage J5 CAC members to continue serving in this vital capacity.

7. How can I contact WPS Medicare? I need mailing addresses and telephone numbers.
WPS Medicare will publish J5 contact information on our Website and in the J5 Listserv for the various workloads throughout the implementation of this contract. We recommend that providers check back often for updates. You can access J5 MAC information at the following address: http://wpsmedicare.com/mac
/index.shtml

8. Will WPS Medicare assign us representative to assist with customer service inquiries?
WPS Medicare does not assign individual provider representatives. We are pleased to offer customer service in many ways and are confident our team will be able to assist you.
J5 providers will have a toll-free line to contact customer service representatives. WPS Medicare follows the Centers for Medicare & Medicaid Services (CMS) directives in the Internet-Only Manual (IOM) Publication 100-09, Medicare Contractor Beneficiary and Provider Communications Manual, Chapter 6, Section 30.1, which outlines the inquiry triage process. In accordance with CMS directives, customer service representatives have authority to refer complex questions to appropriate staff with greater experience and expertise, thus enabling us to answer complex questions, including telephone inquiries requiring a higher level of research. You can read about this process at http://www.cms.hhs.gov/manuals/
downloads/com109c06.pdf on the CMS Provider Website.

9. Does WPS Medicare offer any self-service technologies?
WPS Medicare is pleased to offer a variety of self-service technologies. Our toll-free Interactive Voice Response (IVR) number is available to check eligibility, claims status, and provides a variety of other functions. The WPS Medicare Website, located at www.wpsmedicare.com, is available to assist all providers with many of their questions. The Website contains educational materials such as recorded Webinars, audio recordings, computer-based training modules, guidebooks, educational articles, PowerPoints, etc. Updates to our Website occur on a regular basis

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WPS History, Office Locations, and Contact Info

1. Where can I find out more about WPS?
You can find information about WPS on the following Websites: http://www.wpsic.com for General information and http://www.wpsmedicare.com for Medicare-specific information.

2. How long has WPS been involved in the Medicare business?
Wisconsin Physicians Service (WPS) has been in the Medicare business since the inception of the Medicare program in 1966. We are one of the largest independent contractors for the Medicare program in the nation.

3. Does WPS have other lines of business?
Wisconsin Physicians Service (WPS) Health Insurance is one of the largest health benefits providers in the state of Wisconsin, and after more than 60 years, remains Wisconsin's only not-for-profit insurer offering health plans statewide to the public and private sectors. Our TRICARE division provides claims administration, customer service, and other related activities for the U.S. Department of Defense, serving over 4.7 million beneficiaries worldwide.

4. What are the locations of the WPS Medicare offices?
WPS Medicare has offices in Madison, WI; Marion, IL; Omaha, NE; Bloomington, MN; and Chicago, IL.

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Timetable

1. How long will WPS have this contract?
In accordance with the Medicare Modernization Act (MMA) of 2003, Medicare Administrative Contractors (MAC) contracts must be put up for competitive bidding at least every 5 years.

2. How can I stay up to date with the latest transition news?
You can stay up to date with the latest transition news on the Wisconsin Physicians Service (WPS) Medicare Website.

3. When will WPS begin to process my claims and when will the transition be complete?
See the Transition Timetable at the following Website here

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Page Last Updated: Friday, 09-May-2008 16:48:22 CDT

Frequently Asked Questions

FAQs from the CMS Website

FAQs Answered by WPS Medicare

Claims Processing and Coverage

Electronic Data Interchange (EDI)

Enrollment/ Provider Identification Numbers

General

WPS History, Office Locations, and Contact Info

Timetable

FAQs from the CMS Website

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FAQs Answered by WPS Medicare

Claims Processing and Coverage

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Electronic Data Interchange (EDI)

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Enrollment/Provider Identification Numbers

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General

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WPS History, Office Locations, and Contact Info

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Timetable

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