WPS Medicare at a glance
| Legal name | WPS Government Health Administrators |
|---|---|
| Also known as | WPS GHA, Wisconsin Physicians Service |
| Category | Government program |
| Parent organization | WPS Health Solutions |
| Claims payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| Eligibility (270/271) payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| ERA (835) payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately. Clearinghouse-specific: This registry has not established one national ERA payer ID for WPS Medicare. ERA enrollment and 835 routing are clearinghouse- and product-specific; verify in the payer portal or clearinghouse payer list before enrollment. |
| NAIC company code | Not established in this registry |
| States covered | Nationwide (50 states) |
| Provider resource entry point | https://www.wpsgha.com |
| Provider phone | 1-866-518-3285EDI customer service option 1; confirm jurisdiction and issue before calling |
Always verify claims-routing details against the member ID card and the payer's current EDI companion guide before submission.
Timely filing & appeals for WPS Medicare
This registry lists 365 days as an initial-claim reference for WPS Medicare. Confirm the applicable product, provider agreement, start event and current payer instructions. Do not apply this value automatically to out-of-network, secondary, corrected or appealed claims.
| Submission type | Window |
|---|---|
| Initial claim reference | 365 days (verify applicability) |
| Out-of-network initial claim | Verify the member's plan and applicable out-of-network rules |
| Secondary / coordination of benefits | Verify the allowed window and start event; a primary EOB does not automatically restart filing |
| Corrected claim | Verify correction instructions; do not substitute an appeal deadline |
| Reconsideration / appeal | Use the applicable denial or decision notice and the process below |
This registry has not established a payer-specific appeal ladder for WPS Medicare. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
Source: WPS Medicare provider policy. Always confirm before disputing a TFL denial — payer policies are versioned and product-specific.
Prior authorization with WPS Medicare
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
CMS-0057-F decision-timeframe requirements and exclusions
Verify WPS Medicare electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable. Authorization requirements and submission channels depend on the product, service and delegated reviewer. Verify the applicable policy before scheduling; a portal listing is not proof of X12 278 connectivity.
This registry does not provide a current prior-authorization code list for WPS Medicare. Start with the provider resources or the policy documents below, then confirm the applicable product, service and effective date. A resource link does not establish that a live code-lookup tool is available.
Top denial reasons for WPS Medicare
Per-payer denial benchmarks publish here once the QuickIntell anonymized ETL pipeline ingests sufficient WPS Medicare volume. Until then, see the broader CARC reference for industry-wide remediation guides.
Electronic claims, eligibility & ERA
| Transaction | Registry indication — not verification | Routing reference |
|---|---|---|
| 837P / 837I claims | Listed in registry; verify current scope | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| 270 / 271 eligibility | Listed in registry; verify current scope | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| 278 prior authorization | Listed in registry; verify current scope | Verify X12 278 routing separately |
| 835 ERA | Verify support and enrollment separately | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately. Clearinghouse-specific: This registry has not established one national ERA payer ID for WPS Medicare. ERA enrollment and 835 routing are clearinghouse- and product-specific; verify in the payer portal or clearinghouse payer list before enrollment. |
Payer IDs vary by clearinghouse — confirm against your clearinghouse payer list (Availity, Change Healthcare/Optum, Waystar) before configuring submitter routing.
What revenue cycle teams should verify before submitting claims
- The reviewed 837D guide is a scoped WPS Medicare dental-claim channel. Submitter IDs and contract receiver IDs differ by state; no national routing ID or all-business transaction support is established.
Source checks and remaining limits
The latest partial comparison is dated . Retained earlier findings keep their original dates below. This is a partial source check, not a whole-page, clinical or legal review. It does not refresh the legacy review date above.
provider_phone
Source comparison: 2026-09-26
Visually confirmed 866-518-3285 option 1 is WPS EDI customer service for the Medicare geography listed in the 837D guide, not an undifferentiated national provider claims line.
Primary source for provider_phonepayer_ids / era_payer_id
Source comparison: 2026-09-26
The 837D guide distinguishes submitter identifiers from WPS contract receiver identifiers and varies routing by state. Keep national IDs unset; no numeric ID proposal is made from text-only routing pages.
Primary source for payer_ids / era_payer_idelectronic_claims_supported
Source comparison: 2026-09-26
The official 837D guide substantiates an electronic dental claim channel within its Medicare scope, not every transaction or all WPS-administered business.
Primary source for electronic_claims_supported
Not checked in this pass: Whole-record approval, legal identity, ownership and complete product coverage; Authenticated transactions and QuickIntell integrations; portal_url / supports_279_271 / supports_278: Current homepage returned no usable content. The 837D guide alone does not establish operational portal access or 270/271 and 278 support.; timely_filing_days: No reviewed WPS filing policy substantiates a flat 365-day rule with correct exceptions and calendar handling. Do not derive an exact-day rule from a one-calendar-year Medicare policy..
Sources used for this guide
Medicare coverage policies from Wisconsin Physicians Service Insurance Corporation
The Medicare Coverage Database lists the contracts WPS Medicare holds under the name Wisconsin Physicians Service Insurance Corporation. Wisconsin Physicians Service Insurance Corporation maintains 112 active Local Coverage Determinations across 13 Medicare contracts in the current Medicare Coverage Database export. Each LCD applies only to claims this contractor processes, so the same service can be covered under different criteria by the contractor next door.
Selected active policies from this contractor
A selection, not the full list: policies with measured search demand come first, then those on topics that more contractors publish LCDs for.
- L37228 Wound Care
- L38841 Facet Joint Interventions for Pain Management
- L39054 Epidural Steroid Injections for Pain Management
- L34645 Urine Drug Testing
- L39051 Cosmetic and Reconstructive Surgery
- L35498 Removal of Benign Skin Lesions
States where it is the A/B MAC
All 112 Wisconsin Physicians Service Insurance Corporation LCDs and jurisdictions
Evaluate QuickIntell workflow fit for WPS Medicare
These module references are evaluation starting points, not evidence of a validated connection, supported transaction or customer deployment. Confirm the actual member plan, data access and product scope first.
- QuickRCM
Evaluate claim preparation, follow-up and denial worklists for WPS Medicare; verify the actual plan rules and available connections before implementation.
- QuickAuth
Assess authorization-packet and status workflows for WPS Medicare; confirm product, service, delegated reviewer and permitted submission channels.
- QuickERA
Verify the actual 835 files, posting exceptions and reconciliation requirements for WPS Medicare before evaluating automation. An ERA identifier alone does not establish supported ingestion or posting.
- QuickCode
Evaluate documentation and coding-review controls for WPS Medicare; require applicable sources and qualified review rather than assuming payer-specific edits are configured.
Frequently asked questions about WPS Medicare
Where is the WPS Medicare provider portal?
Use https://www.wpsgha.com as a starting point for WPS Medicare provider resources. This link may open a directory or contact page rather than a transaction portal. Select the applicable product and administrator, then verify the available functions, enrollment and access requirements. QuickIntell is not the official payer portal.
What is the timely filing limit for WPS Medicare?
This registry lists 365 days as an initial-claim reference for WPS Medicare. Confirm the applicable product, provider agreement, start event and current payer instructions. Do not apply this value automatically to out-of-network, secondary, corrected or appealed claims.
Does WPS Medicare publish a single claims payer ID?
This registry has not established one all-product claims payer ID for WPS Medicare. See the source findings for transaction-specific references. Look up the correct ID for the member's plan and transaction in your clearinghouse directory and verify against the member ID card before submission.
Does WPS Medicare accept electronic claims?
Verify WPS Medicare electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable.
How do I appeal a WPS Medicare denial?
This registry has not established a payer-specific appeal ladder for WPS Medicare. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
How long do WPS Medicare prior authorization approvals take?
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
What is the WPS Medicare provider phone number?
This registry lists 1-866-518-3285 as a contact reference for WPS Medicare. EDI customer service option 1; confirm jurisdiction and issue before calling
Automate workflows around WPS Medicare requirements
Connect eligibility, prior authorization, pre-submission claim checks, and remittance routing in one governed workflow. Payer and plan configuration is confirmed during implementation.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. Payer policies change without notice — always verify against WPS Medicare's current published documents before submission. CPT® is a registered trademark of the American Medical Association.