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DDE Electronic Access Request Form

Use this form to request new access or modify access for an existing user who works for a provider office, corporate office, central billing office (CBO), or Third Party Billing Company. Use of this form requires a DDE Submitter ID.
 

WPS GHA PART A
For instructions on completing this form, please click here.

If you do not have a WPS GHA DDE Submitter ID, you may be able to create one using this link: Submitter ID Form

  • Requests with an invalid DDE Submitter ID will not be processed.
  • Your DDE Submitter ID is NOT your EDC ID
  • It is an ID that you have received from the WPS GHA DDE department specifically for requesting DDE access for your users.

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Need Help?

Contact us about Direct Data Entry (DDE) forms:

  •  (866) 518-3295