Terms of Use for Transactional Areas
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Terms of Use for Transactional Areas
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Terms and Conditions
WPS GHA Portal - Terms of Use for Transactional Areas
Reviewed February 28, 2023
Updated March 1, 2023
By registering for and accessing the transactional areas of the WPS GHA Portal Website (the “Transactional Areas”), you agree to be bound by the following terms and conditions. If you do not wish to be bound by these terms and conditions, you should not access or use Transactional Areas. Please save and/or print a copy of these Terms of Use for Transactional Areas. The Terms of Use for Transactional Areas apply in addition to the General Terms of Use.
Amendments to Terms of Use
WPS may amend these Terms of Use from time to time. If we do, we will publish the changes on this Website. It is your responsibility to check the Website periodically for changes to these Terms of Use. Your continued use of the Website following the posting of revised Terms of Use means that you accept and agree to the changes.
Protected Health Information
The Centers for Medicare & Medicaid Services (“CMS”) and Wisconsin Physicians Service Insurance Corporation (“WPS”) are committed to maintaining the integrity and security of health care data in accordance with applicable laws and regulations. Disclosure of Medicare beneficiary data is restricted under the provisions of the Privacy Act of 1974 and the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). Violation of these laws can result in monetary fines and/or criminal charges that may result in imprisonment. While using the Transactional Areas, you must:
• Use appropriate safeguards to prevent improper use or disclosure of Protected Health Information (“PHI”) and Personally Identifiable Information (“PII”) according to CMS regulations and the WPS Privacy Policy;
• Use PHI only for the purposes for which it was collected;
• Not attempt to exceed authorized access to PHI/PII; and
• Only access PHI/PII necessary to perform job functions (i.e., "need to know" or "minimum necessary").
Transactional Area User IDs and Passwords
A user ID and password is assigned to each individual who registers for access to the Transactional Areas. Only one user ID is allowed per person. Individuals are strictly forbidden from using another person's account, identity, user ID, or password. Do not lend, share, or "hand off" your user ID and/or disclose your password. Sharing of accounts may lead to termination of system access privileges and/or other adverse action. You are responsible for ensuring that sufficient security measures are in place to keep your password secure and confidential. You can be held responsible for the consequences of unauthorized or illegal transactions performed with your user ID or password.
WPS may add, modify or discontinue functionality within the Transactional Areas without advance notice. WPS may also add, modify or discontinue service availability or the hardware/software requirements for use with the Transactional Areas without advance notice. However, WPS will provide advance notice to users when practicable.
Administrator Responsibilities
Each user ID is associated with a National Provider Identifier (NPI). One NPI may be associated with multiple user IDs. Each NPI must have, at a minimum, one administrator (“NPI Administrator”). The NPI Administrator is a user with additional authority to grant or deny access to the NPI for other Portal users. If you are an NPI Administrator, it is your responsibility to identify and enroll/approve standard users, and to authorize, monitor, and control the access of standard users. Users shall have access to the Transactional Areas based upon the roles established during the registration process or by the NPI Administrator. The NPI Administrator is responsible for removing access for users who are no longer authorized and/or required to access the Transactional Areas.
The NPI Administrator is also responsible for completing thorough user review every 90 days to assure all active accounts are in compliance. The NPI Administrator’s user review shall include the following steps:
- Verifying all active user accounts listed for each of the NPI’s they administers have appropriate Portal role access (Standard or Eligibility Only) and correcting if necessary.
- Verifying all active user accounts are current employees or members of the NPI organization and that the user should still have access to the WPS GHA Portal.
- If a user is no longer employed with the associated NPI, disabling the user account or removing the NPI location access immediately.
Annual Security Awareness Training
Individuals with access to the Transactional Areas must attest that they have completed their company's annual security awareness training during the yearly re-certification process.
User Conduct
Transactional Area users must adhere to the CMS Information Security Policies, Standards, and Procedures. Misuse of this system is subject to civil and criminal penalties for falsifying information, wrongfully obtaining information, and wrongful disclosure of information obtained in the Transactional Areas. Unauthorized access to the Transactional Areas and information contained within the Transactional Areas is prohibited and is a punishable offense subject to fines and imprisonment.
Rules of Behavior
The Transactional Areas interface with the Medicare HIPAA Eligibility Transaction System (“HETS”). By accessing HETS, you agree to comply with the Medicare Rules of Behavior 
. The Medicare Rules of Behavior outline your responsibility in obtaining, disseminating, and using beneficiary's Medicare eligibility data. The release of eligibility data to providers or their authorized billing agents is only allowed for the purpose of preparing an accurate Medicare claim or verifying eligibility for specific services.
Determining Medicare Eligibility
The Transactional Areas shall only be used to verify, and not determine, Medicare beneficiary eligibility. Unauthorized transactions include attempting to acquire the beneficiary's Medicare Number when it is not known and determining eligibility for Medicare without first screening the patient.
Automated Interfaces
The use of any automated application, program, or macro (among other examples) that interfaces with the Transactional Areas is prohibited. The Transactional Areas are a stand-alone resource and shall only be used "as is" by the user.
Medicare Information Databases
Users are not authorized to use the Transactional Areas’ eligibility and claim status functions to create non-CMS controlled Medicare databases. Users cannot create and/or host local Medicare eligibility and claim status databases that replicate functionality of the Transactional Areas.
Monitoring of Usage
Your usage of the Transactional Areas may be monitored, recorded, and audited. Logging into the Transactional Areas establishes your consent to any and all monitoring and recording of your activities and information. We monitor network traffic to identify unauthorized attempts to upload or change information or otherwise cause damage to the web service. Unauthorized attempts to upload information and/or change information on the Transactional Areas are strictly prohibited.
Users identified as having aberrant behavior (e.g., high volume transaction rates indicating automation, searching for correct Medicare number) may be contacted to verify and/or address improper use of the system or, when appropriate, be referred for investigation.
Termination and Suspension
Transactional Area user accounts may be suspended and/or terminated by WPS at any time without notice. Transactional Area user accounts will be suspended if suspicious behavior is observed or suspected and when the number of user errors exceeds parameterized values for either consecutive errors, or the number of total errors. Users of the Transactional Areas must exercise caution to ensure that accurate information is entered into the Transactional Areas in order to prevent user suspension. After a user account is suspended, the user must submit a written corrective action plan to WPS.
Electronic Signatures
Electronic signatures are captured throughout the Transactional Areas, for example, at the time of initial registration and with all claim appeal requests. By signing your electronic signature is kept as a record that you understand, acknowledge, and agree that you are bound by the Transactional Areas’ terms and conditions. In addition, by electronically signing you attest to your identity and that you are acting in good faith. WPS and CMS may, at any time, request you prove your identity, relationship, and authorization to access information within the Transactional Areas.
Local System Requirements
You are responsible for obtaining, installing, maintaining, and operating all computer hardware and software necessary for accessing the Transactional Areas. WPS will not be responsible for any errors or failures from the malfunction or failure of your hardware or software. WPS supports the Transactional Areas on Microsoft Edge and Google Chrome. The Transactional Areas should also work with other Internet browsers (such as Internet Explorer, Firefox, Opera, and Safari); however, WPS does not guarantee their compatibility with the Transactional Areas. Transport Layer Security (TLS) should be set at TLS 1.2 or higher on Internet Explorer. You are responsible for maintaining appropriate security of your hardware, software, networks, and information systems when accessing the WPS GHA Portal and the Transactional Areas.
No Guarantee of Benefits
The data presented within the Transactional Areas is not a guarantee of benefits. Benefits will be determined at the time a claim is processed.
System Availability
In general, the Transactional Areas are available 24 hours a day, 7 days a week. The Transactional Areas may experience occasional outages for routine system maintenance, normally completed after business hours. Business hours are defined as 7:00 a.m. to 5:00 p.m. central time, Monday through Friday.
Our maintenance schedule is as follows:
- Every night from Sunday to Friday, the system will be unavailable from 10:00 PM to 5:00 AM the following morning.
- For a larger weekend window, the system will be unavailable from Saturday 12:00 PM to Sunday 10:00 AM.
Because the Transactional Areas rely on third party (external) data sources, the availability and outages of some Transactional Area functions, such as eligibility and claim status, are not controlled by WPS. Standard shared system business hours are routinely 6:00 a.m. to 7:00 p.m. central time, Monday through Friday. WPS makes a concerted effort to inform users of outages outside of these times through broadcast notifications.
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