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Terms and Conditions
Updated March 5, 2021
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 PHI only for the purposes for which it was collected;
• Not attempt to exceed authorized access to sensitive information; and
• Only access sensitive information 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.
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 he/she 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 for 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.
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, which are available at www.cms.gov. 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.
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. 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 at any time without notice. Transactional Area user accounts will be suspended if suspicious behavior is 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 are captured throughout the Transactional Areas, for example, at the time of initial registration and with all claim appeal requests. Your electronic signature is kept as a record that binds you to 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 Internet Explorer. The Transactional Areas should also work with other Internet browsers (such as 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.
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.
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.
Updated March 5, 2021
The WPS GHA Portal Website is composed of various web pages operated by Wisconsin Physicians Service Insurance Corporation (“WPS”). The capitalized term “Website” shall be defined herein to include wpsgha.com and all other web pages operated or hosted exclusively by WPS for health care providers in Medicare Jurisdiction 5 (“J5”) and Jurisdiction 8 (“J8”), including the transactional areas of the WPS GHA Portal that require user registration to access.
You agree not to:
- use or access the Website for any fraudulent or unlawful purpose;
- use or access the Website to impersonate any person or entity;
- interfere with or disrupt the operation of the Website or access to it;
- transmit or otherwise make available in connection with the Website or access to it any virus, worm, Trojan horse, time bomb, spyware, or other harmful computer code, file, or program;
- restrict or inhibit the ability of any other person to access or use the Website;
- modify, adapt or translate any portion of the Website;
- remove, obscure or modify any copyright, trade mark, or other proprietary rights notice from the Website; and
- obtain or attempt to obtain any materials or information through any means not intentionally made available or provided for through the Website, including, but not limited to, data mining, robots, or similar data gathering and extraction tools.
Products and Services Void Where Prohibited
Although the information on this Website is accessible worldwide, not all services discussed in this Website are available to all persons or in all geographic locations or jurisdictions. To the extent permitted by law, WPS reserves the right to limit the provision of its services to any person, geographic area, or jurisdiction and to limit the quantities of any services that WPS provides. Any offer for any service made in the materials on this Website is void where prohibited and/or WPS is not licensed or admitted to do business. Nothing in this Website implies that WPS provides, or intends to provide, such services in your area, jurisdiction, state or country.
The Website is designed to provide general information about WPS and its administration of Medicare in J5 and J8, as well as access to eligibility and claims data. The eligibility and claims data displayed by the Transactional Areas originates from several third party (external) data centers, which are ultimately responsible for the data content provided to the Website. Although WPS strives to ensure its accuracy and integrity, information on this Website and documents available from this server are provided "as is" without warranty of any kind, either express or implied, including, but not limited to, the implied warranties of merchantability, fitness for a particular purpose, or non-infringement. Some jurisdictions do not allow the exclusion of implied warranties, so the above exclusion may not apply to you. WPS does not represent or guarantee that your use of information or documents from this Website would not infringe privately owned rights.
Information on this Website may contain out of date information, technical inaccuracies and typographical errors. WPS assumes no responsibility or liability for damages incurred directly or indirectly as a result of any errors, omissions, or discrepancies. Information may be changed or updated by WPS at any time without notice. WPS may also make improvements and/or changes in the services described in this information at any time without notice.
The information on this Website is limited in nature and therefore may be incomplete. For example, it may not contain all of the applicable terms, conditions, limitations or exclusions of the services referenced.
The views and opinions of third party authors published on this Website do not necessarily reflect those of WPS.
Intellectual Property Rights
All content included on this Website, such as text, graphics, logos, button icons, images, audio and video clips, and software, is either the exclusive property of WPS or duly licensed by third parties. All content is protected by United States of America and international copyright laws and all such rights are reserved. The content on this Website may be used as an informational resource only. Any other use, including the reproduction, modification, distribution, transmission, republication, display or performance of the contents on this Website is strictly prohibited.
The contents of this Website's pages, including, but not limited to, text, graphics, logos, button icons, images, audio and video clips, and software, are copyrighted materials owned and/or controlled by WPS and contain WPS's trademarks, service marks, and trade names. Users of this Website may download one copy of these materials on any single computer and print a copy of the materials for the user's use in learning about, evaluating, or acquiring WPS's services. No other permission is granted to any user to print, copy, reproduce, distribute, transmit, upload, download, store, display in public, alter, or modify these materials. No permission is granted to any user to use WPS's icons, site address, or other means to hyperlink other Internet sites with any page in this Website, and WPS assumes no responsibility, obligation or liability for any other party's website that is hyperlinked to this Website or in which any part of this Website has been hyperlinked.
This Website contains hyperlinks (“links”) to and frames of websites that are not maintained by WPS. WPS makes no representations whatsoever about any other website that may be accessed through or hyperlinked to this Website. Any non-WPS website is independent from WPS and WPS has no control over its content or privacy practices. While WPS tries to include only links to or frames of websites that are of good quality, WPS cannot guarantee that those websites will not change without WPS's knowledge. WPS’s inclusion of such links and frames in this Website is for your convenience only and does not imply WPS's endorsement or recommendation of the linked or framed websites or their content or privacy practices. WPS does not accept any responsibility, obligation or liability for damages arising out of your use of such non-WPS websites.
No information, statements, links, or references to any specific commercial products, processes, or services by trade name, trademark, or manufacturer should be interpreted as an endorsement or recommendation by WPS.
Limitation of Liability
IN NO EVENT WILL WPS BE RESPONSIBLE OR LIABLE TO ANY PARTY FOR ANY DIRECT, INDIRECT, SPECIAL, PUNITIVE OR CONSEQUENTIAL DAMAGES FOR ANY USE OF THIS WEBSITE, OR ON ANY OTHER HYPERLINKED WEBSITE, INCLUDING, BUT NOT LIMITED TO, ANY LOST PROFITS, BUSINESS INTERRUPTION, LOSS OF PROGRAMS OR OTHER DATA ON ANY INFORMATION HANDLING SYSTEM OR OTHERWISE, EVEN IF WPS IS EXPRESSLY ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.
This disclaimer of responsibility and liability applies to any damages or injury caused by any failure of performance, error, omission, interruption, deletion, defect, delay in operation or transmission, computer virus, communication line failure, theft or destruction or unauthorized access to, alteration of, or use of record, whether for breach of contract, tortious behavior, negligence, or under any other cause of action. By using this Website, the user specifically acknowledges that WPS is not responsible or liable for any user's or any third party's defamatory, offensive, infringing, or illegal information, materials or conduct, and WPS reserves the right to remove such information or materials from this Website without liability.
Any comments or materials sent to WPS, including, but not limited to, feedback data, questions, comments, suggestions, or the like, regarding the content of this Website (collectively "Feedback") shall be deemed to be non-confidential and provided free and without fee, charge, or cost to WPS. WPS shall have no responsibility, obligation or liability of any kind with respect to such Feedback and shall be free to reproduce, delete, destroy, use, disclose, exhibit, display, transform, create derivative works and distribute the Feedback to others without limitation. Further, WPS shall be free to use any ideas, concepts, know-how, methodology, or techniques contained in such Feedback for any purpose whatsoever, including, but not limited to, developing and marketing products or services incorporating such Feedback.
Privacy and Personal Information
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