Portal User Manual – Claim Status
Need help?
Contact Us About Claims
Claim Status/Patient Eligibility:
(866) 518-3285
24 hours a day, 7 days a week
Claim Corrections:
(866) 518-3253
7:00 am to 4:30 pm CT M-Th
DDE Navigation & Password Reset: (866) 518-3251
7:00 am to 4:30 pm CT M-F
DDE System Access: (866) 518-3295
7:00 am to 4:30 pm CT M-F
EDI: (866) 518-3285
7:00 am to 5:00 pm CT M-F
General Inquiries:
(866) 518-3285
7:00 am to 5:00 pm CT M-F
Claim Status/Patient Eligibility:
(866) 234-7331
24 hours a day, 7 days a week
Claim Corrections:
(866) 580-5980
8:00 am to 5:30 pm ET M-Th
DDE Navigation & Password Reset: (866) 580-5986
8:00 am to 5:30 pm ET M-F
DDE System Access: (866) 518-3295
8:00 am to 5:30 pm ET M-F
EDI: (866) 234-7331
8:00 am to 5:00 pm ET M-F
General Inquiries:
(866) 234-7331
8:00 am to 5:00 pm ET M-F
Claim Status/Patient Eligibility:
(866) 518-3285
24 hours a day, 7 days a week
Claim Corrections/Reopenings:
(866) 518-3285
7:00 am to 5:00 pm CT M-F
EDI: (866) 518-3285
7:00am to 5:00 pm CT M-F
General Inquiries:
(866) 518-3285
7:00 am to 5:00 pm CT M-F
Claim Status/Patient Eligibility:
(866) 234-7331
24 hours a day, 7 days a week
Claim Corrections/Reopenings:
(866) 234-7331
8:00 am to 5:00 pm ET M-F
EDI: (866) 234-7331
8:00 am to 5:00 pm ET M-F
General Inquiries:
(866) 234-7331
8:00 am to 5:00 pm ET M-F
Need help?
General questions about Medical Review
(866) 518-3285
7:00 am to 5:00 pm CT M-F
(866) 234-7331
8:00 am to 5:00 pm ET M-F
(866) 518-3285
7:00 am to 5:00 pm CT M-F
(866) 234-7331
8:00 am to 5:00 pm ET M-F
Need help?
Contact Us About Overpayments
Inquiries regarding refunds to Medicare - MSP Related
(866) 518-3285
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-Fri
Secondary.Payer.Inquiry@wpsic.com
Inquiries regarding overpayments NOT associated with MSP
(866) 518-3285
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-Fri
Reimbursement.Overpayment.
Inquiry@wpsic.com
Inquiries regarding refunds to Medicare - MSP Related
(866) 234-7331
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-Fri
Secondary.Payer.Inquiry@wpsic.com
Inquiries regarding overpayments NOT associated with MSP
(866) 234-7331
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-Fri
Reimbursement.Overpayment.
Inquiry@wpsic.com
Questions regarding overpayments associated with MSP related debt
(866) 518-3285
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-Fri
Secondary.Payer.Inquiry@wpsic.com
Questions regarding overpayments NOT associated with MSP related debt
(866) 518-3285
7:00 am to 5:00 pm CT (8:00 am to 6:00pm ET) M-Fri
Payment.Recovery.Inquiry@wpsic.com
Questions regarding overpayments associated with MSP related debt
(866) 234-7331
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-Fri
Secondary.Payer.Inquiry@wpsic.com
Questions regarding overpayments NOT associated with MSP related debt
(866) 234-7331
8:00 am to 5:00 pm ET (7:00 am to 4:00pm CT) M-Fri
Payment.Recovery.Inquiry@wpsic.com
Need help?
Contact us about Appeals
7:00 am to 5:00 pm CT M-F
8:00 am to 5:00 pm ET M-F
7:00 am to 5:00 pm CT M-F
8:00 am to 5:00 pm ET M-F
Need help?
Contact Us About Provider Enrollment
(866) 518-3285
7:00 AM - 5:00 PM CT, Monday - Friday
USPS Mailing Address
WPS GHA
Medicare Provider Enrollment
P.O. Box 8248
Madison, WI 53708-8248
Overnight Delivery
WPS GHA
Medicare Provider Enrollment
1717 W. Broadway
Madison, WI 53713-1834
(866) 234-7331
8:00 AM - 5:00 PM ET, Monday - Friday
USPS Mailing Address
WPS GHA
Medicare Provider Enrollment
P.O. Box 8248
Madison, WI 53708-8248
Overnight Delivery
WPS GHA
Medicare Provider Enrollment
1717 W. Broadway
Madison, WI 53713-1834
(866) 518-3285
7:00 AM - 5:00 PM CT, Monday - Friday
USPS Mailing Address
WPS GHA
Medicare Provider Enrollment
P.O. Box 8248
Madison, WI 53708-8248
Overnight Delivery
WPS GHA
Medicare Provider Enrollment
1717 W. Broadway
Madison, WI 53713-1834
(866) 234-7331
8:00 AM - 5:00 PM ET, Monday - Friday
USPS Mailing Address
WPS GHA
Medicare Provider Enrollment
P.O. Box 8248
Madison, WI 53708-8248
Overnight Delivery
WPS GHA
Medicare Provider Enrollment
1717 W. Broadway
Madison, WI 53713-1834
Need help?
Contact us about Policies
(866) 518-3285 - General questions about Policies
7:00 am to 5:00 pm CT M-F
(866) 234-7331 - General questions about Policies
8:00 am to 5:00 pm ET M-F
(866) 518-3285 - General questions about Policies
7:00 am to 5:00 pm CT M-F
(866) 234-7331 - General questions about Policies
8:00 am to 5:00 pm ET M-F
LCD Reconsideration Request: Policycomments@wpsic.com
Draft LCD Comments: Policycomments@wpsic.com
IDE Submissions: IDE.mailbox@wpsic.com
RSVP for Open Meeting and CAC: LCDCAC@wpsic.com
Questions about Payments and Incentive Programs
(866) 518-3285
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-F
Contact us about Form CMS-588 Electronic Funds Transfer (EFT)
(866) 518-3285
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-F
Financial.Reporting.Inquiry@wpsic.com
Do not submit PHI/PII through email
Questions about Payments and Incentive Programs
(866) 234-7331
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-F
Contact us about Form CMS-588 Electronic Funds Transfer (EFT)
(866) 234-7331
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-F
Financial.Reporting.Inquiry@wpsic.com
Do not submit PHI/PII through email
Questions about Payments, Fee Schedules, and Incentive Programs
(866) 518-3285
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-F
Contact us about Form CMS-588 Electronic Funds Transfer (EFT)
(866) 518-3285
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-F
Financial.Reporting.Inquiry@wpsic.com
Do not submit PHI/PII through email
Questions about Payments, Fee Schedules, and Incentive Programs
(866) 234-7331
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-F
Contact us about Form CMS-588 Electronic Funds Transfer (EFT)
(866) 234-7331
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-F
Financial.Reporting.Inquiry@wpsic.com
Do not submit PHI/PII through email
Need help?
Need help?
Mail audit materials:
WPS GHA
ATTN: Audit Supervisor
P.O. Box 8696
Madison, WI 53708-8696
When using a delivery service:
WPS GHA
ATTN: Audit Supervisor
1717 W. Broadway
Madison, WI 53713-1834
Mail audit materials:
WPS GHA
ATTN: Audit Supervisor
P.O. Box 14172
Madison, WI 53708-0172
When using a delivery service:
WPS GHA
ATTN: Audit Supervisor
1717 W. Broadway
Madison, WI 53713-1834
Need help?
Try these links first.
Questions about Self-Service?
(866) 518-3285
7:00 am to 5:00 pm CT M-F
Try these links first.
Questions about Self-Service?
(866) 518-3285
7:00 am to 5:00 pm CT M-F
Try these links first.
Questions about Self-Service?
(866) 234-7331
8:00 am to 5:00 pm ET M-F
Try these links first.
Questions about Self-Service?
(866) 234-7331
8:00 am to 5:00 pm ET M-F
Portal User Manual – Claim Status
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Print the complete Portal User Manual
The Claim Inquiry function allows Standard users and NPI Administrators users to check the status of pending and processed claims. It is also the starting point for several other claim-related transactions in the portal.
Claim status is available only when the claims processing system is available. Both the FISS (Part A/facilities) and MCS (Part B/practitioners and suppliers) claims processing systems go offline around 7:00 PM CT (8:00 PM ET) nightly. They generally come back online at the following times:
FISS (Part A)
J5 (IA, KS, MO, NE) 6:00 AM CT (7:00 AM ET)
J5 National 7:00 AM CT (8:00 AM ET)
J8 (IN, MI) 5:00 AM CT (6:00 AM ET)
MCS (Part B)
J5 (IA, KS, MO, NE) 7:00 AM CT (8:00 AM ET)
J8 (IN, MI) 5:00 AM CT (6:00 AM ET)
Claim Search
To check the status of a claim, begin by selecting the Claim Inquiry/Entry link under the Claims heading in the left navigation menu. (If you do not see the Claim Inquiry/Entry link, click the arrow next to Claims to open the Claims menu.)
On the Claim Search screen, enter the following, then click the Search button to locate any claims meeting the criteria:
- Service location (NPI)
- Patient’s Medicare number
- Start and end dates of service
The portal will display your search criteria near at the top of the page. A list of claims meeting the search criteria appears at the bottom of the page.
Click the buttons at the top of the page to refine your current search, start a new search, submit a new claim (if you are registered to submit Part B claims through the WPS Government Health Administrators Portal), or print the information on the page.
The claim results provide high-level information about the claim. Click the claim number to view more details about the claim or perform additional claim actions.
You may also be able to access the following claim actions directly from the claim results page, depending on the type of claim submitted. You will only be able to select a button if your claim qualifies for that action.
- MR: Respond to an Additional Development Request (ADR) letter sent by Medical Review (pending claims only)
- CER: Perform a Clerical Error Reopening to correct minor errors or omissions (finalized claims only)
- OCA: Perform an Overpayment Claim Adjustment to report an overpayment (finalized claims only)
NOTE: Older Part A claims may be archived. Archived claims appear in the claim results, but claim details are not available. Please contact our Provider Contact Center for help if you receive a message stating a claim is archived.
Claim Details
Clicking the claim number shows addition details and actions for the claim. The information displayed varies depending on if the claim is an institutional (i.e., Part A) claim or a professional (i.e., Part B) claim.
Institutional and professional claim details include the following information:
- Date(s) of service
- Patient’s name and Medicare number
- Claim number (DCN/ICN)
- Claim status (i.e., Adjusted/Replaced, Processed, Finalized/Paid, In Process, Denied, Cancelled, Approved, etc.)
- Processed date
- Check/EFT number
- Check or paid date (RA date)
- Billed amount
- Allowed amount
- Paid amount
- Deductible applied
- Lines of service and their details (HCPCS/CPT codes, modifiers, revenue codes, units, etc.)
- Reason and/or remark codes
Institutional claims may also include:
- Type of bill
- Status/Location
- Blood deductible
- Discharge facility type
NOTE: In the Claim Details table, you can click on an underlined code for a definition of that code.
Claim Actions
The Claim Actions section (located in the middle of the claim details) shows actions you can take on the claim. Not all actions are available for every claim. Actions available may include:
- Add Documentation [ADR or MR] (to upload documentation requested by the Medical Review department for a pre- or post-pay review; do not use this option to appeal a claim determination)
- Download Remit
- Reopen (Clerical Error) [CER] (to correct minor errors or omissions)
- Report Overpayment [OCA]
- Request Redetermination (to appeal Medicare’s claim decision)
- Check Patient’s Eligibility
Example of an institutional claim’s details page:
Example of a professional claim’s details page:
More Info Button
The More Info button provides additional details about the claim. On institutional and professional claims, you may see the More Info button next to each claim detail line. When the button appears next to the claim line, the information may include:
- Rendering provider name
- Rendering provider NPI
- ANSI reason and remarks codes
- Related claim link (a claim that may be duplicative of your claim)
- Patient eligibility information
Institutional claims may also include a More Info button next to a claim level reason code (i.e., a reason code that applies to the entire claim).
Enhanced Denial Information
Enhanced denial information is available for some denials. If enhanced denial information is available, it may provide:
- Additional information explaining the denial
- Guidance for correcting the claim
- Links to web pages containing information applicable to your claim
- Claim action buttons for correcting the denial (may not be available for all denials)
A list of denial reason codes with more information available can be found in, “Self Service Denial Assistance is Available with the More Info Button.”
global-tags: J8A,J5A,J8B,J5B
.
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