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Part B providers who submit paper claims using the CMS-1500 claim form can register to submit claims through the portal. Since portal claims are processed as electronic claims, paper billers can receive many of the same benefits of electronic claim submission, including quicker payment of claims. This option is only available to Part B providers who are not already registered to submit electronic claims through traditional electronic data interchange (EDI) methods.

Registering for Claim Entry Through the Portal

Step 1: From the left navigation menu, select the Claim Inquiry/Entry link from the Claims menu.

Step 2: Click the Claim Entry Registration button to open the registration instructions.

Step 3: Click one of the links to the registration form in the instructions. We recommend printing the instructions or opening the form in a separate window to ensure you complete the registration form correctly. 

Step 4: Use the data in the instructions to complete the EDI Express Enrollment form. If you have any questions about the enrollment process or the form, contact the WPS Electronic Data Interchange (EDI) department for assistance. 

Step 5: The WPS EDI staff will send an email notifying you when your enrollment is complete. Please allow up to 30 days to process your request.

NOTE: Your ability to submit claims through the portal is tied to your User ID. If your User ID is ever disabled, be sure to reactivate your existing User ID instead of creating a new one. If you create a new User ID, you will need to re-enroll to continue submitting claims through the portal under your new username.

Submitting Part B Claims Through the Portal

Providers enrolled and approved to submit claims through the portal can submit most types of Part B claims through the portal. The following types of claims CANNOT be submitted through the WPS Government Health Administrators Portal:

• Medicare Secondary Payer (MSP) 
• Medigap (i.e., claims that require the provider to enter the supplemental insurer’s information in Item 9 of the CMS-1500 claim forms)
• Hospice (i.e., place of service 34)
• Purchased services (i.e., anti-markup tests, formerly known as purchased diagnostic tests)

General Instructions for Portal Claim Entry

Step 1: From the left navigation menu, select the Claim Inquiry/Entry link from the Claims menu.

Step 2: Click the Submit New Claim button to open the claim form.

Step 3: You will enter information into the portal claim form in a different order than you do on the paper CMS 1500 claim form. For your convenience, most fields refer to where the information appears on the CMS 1500 claim form.

Step 4: Complete all fields marked with an asterisk (*) in each section. Depending on the type of service you are billing, you may also be required to complete some fields that are not marked with an asterisk. 

Step 5: Enter the billing provider’s information. Below the Federal Tax ID Number field, be sure to indicate what type of tax ID number is entered (e.g., SSN for Social Security Number or EIN for Employer Identification Number).

Step 6: Enter the patient’s information. The patient’s name should match the information on their Medicare card.

Step 7: Enter the required header information. 

• You MUST select one of the following options in the drop-down box shown below: 
  • None of the following apply to my claim (Select if you are billing for services other than the ones listed.) 
  • Ambulance Service
  • Global Surgery
  • Laboratory
  • Chiropractic Service
  • OT/PT
  • Inpatient Services
  • Mammography
• Depending on the type of service selected, the portal claim form will display additional claim fields that must be completed for Medicare to process your claim. See the Claim Entry Instructions for Specific Claims section below for more information. 

Step 8: Enter the optional header information. which includes the service facility information (name, NPI, and full address), the referring provider information (name and NPI), and other miscellaneous data.

NOTE: “Optional” in this section means the information is not required for all claims. Depending on the type of service you are billing, the information in this section may be required to process your claim. Failure to include the information may make your claim unprocessable or result in an overpayment or underpayment.

• Do not list more than one ordering/referring provider per claim. Submit separate claims for each ordering/referring provider.
• The Comments field (i.e., Item 19 on the CMS 1500 claim form) allows up to 80 characters.
• Enter the Investigational Device Exemption (IDE) number when an investigational device is used in an approved IDE clinical study.
• The Patient Account number field is for the provider’s tracking purposes. It will appear on the remittance advice. Medicare does not use this information to process the claim.
• The Patient Paid Amount field is only used to report payments your patient made out-of-pocket. Do not use this field to report a primary payment by another insurer or your claim will not be paid correctly. 

Step 9: Enter the diagnosis codes that apply to the claim. 

• Enter the primary diagnosis in the first position.
• Enter any additional diagnosis codes that apply to the claim in the remaining fields.
• Leave the fields blank if they do not apply.
• Do not enter decimal points. 

Step 10: Enter claim line details. 

• Modifier: List modifiers that affect payment before modifiers that are informational only.
• Diagnosis Pointer: Enter the number corresponding to the diagnosis codes listed in the Diagnosis Codes section (i.e., numbers 1-12) of the claim. Do not enter the full diagnosis code.
• Anesthesia: If you indicate the line item is for anesthesia, the Units field will change to Minutes to allow you to enter the number of anesthesia minutes.
• NOC Description: If you enter a “not otherwise classified” (NOC) or unlisted code, enter a description of the code. The description can be up to 80 characters. Do not use an NOC code if a valid true code exists.

Step 11: To add additional lines of service to the claim, select the total number of lines from the drop-down box in the upper right corner of Line 1, or click “Add new line” at the bottom of each claim line to add lines one at a time.

Step 12: Click the Delete Line button that appears next to the second and subsequent lines if you accidentally add too many lines of service to the claim.

Step 13: Once you enter all claim lines, click the Review button to review the claim. After clicking the Review button, an Edit button and a Submit button will also appear.

Step 14: The portal will review your claim for errors and display a message at the top of the Claims page indicating what needs to be corrected. Click the Edit button to correct errors or make other changes. (NOTE: The portal does not perform front end editing of your claim. The claims processing system could still reject your claim for incomplete or invalid information after it is submitted.)

Step 15: When you are satisfied the claim is entered correctly, click the Submit button to submit your claim to Medicare and receive a confirmation number. You can print the confirmation page for your records. If Medicare’s claims processing system rejects your claim, the confirmation number will be referenced in your educational material.

Allow three business days before checking the status of your claim in the portal or the Interactive Voice Response (IVR) system.

Claim Entry Instructions for Specific Claims

Some commonly rendered services require providers to include additional information on their claims for payment. When selecting one of the services below from the drop-down box in the Required Header Information section, the portal will provide additional fields that must be completed:

Ambulance Services

• Pick up Location Address: Enter the complete address where the patient was picked up.
• Drop-off Location Name and Address: Enter name of the facility and the complete address where the patient was dropped off.
• Reason for Transport: Select the main reason for the transport. 
• Purpose of Round Trip: Explain the reason for a round trip, if appropriate.
• Stretcher Purpose Description: Explain the reason the patient needed to be transported by stretcher.
• Transport Distance in Miles: The transport distance is required when a reason for transport is selected.
• Condition of patient: Select all conditions that apply to the ambulance service.

Chiropractic Service

• Initial Treatment Date: Enter the date the chiropractor initiated the course of treatment.

Global Surgery

• Assumed Care Date: Enter the date the provider assumed post-operative care of the patient (if post-operative care was shared with another provider)
• Relinquished Care Date: Enter the date the provider relinquished post-operative care of the patient.
• Inpatient Services
• Admit Date: Enter the date the patient was admitted to the facility.
• Discharge Date: Enter the date the patient was discharged from the facility, if known.

Laboratory

• CLIA#: Enter the 10-digit Clinical Laboratory Improvement Amendments (CLIA) number of the laboratory that performed the lab procedure(s).
• Referring CLIA#: Enter the 10-digit CLIA number for the referring laboratory if the lab specimen was referred to another laboratory for testing.

Mammography

• Mammography Certification #: Enter the six-digit FDA certified Mammography Certification number.

Occupational Therapy/Physical Therapy (OT/PT)

• Date Last Seen: Enter the date the patient last saw the supervising provider
• Supervising Physician Name: Enter the first and last name of the attending physician/non-physician practitioner (NPP)
• Supervising Physician NPI: Enter the NPI of the attending physician/NPP
• NOTE: The supervising physician’s name and NPI are optional; however, if you enter information in one of these fields, you must complete them all.

Routine Foot Care

• Date Last Seen: Enter the date the patient last saw their attending physician.
• Supervising Physician Name: Enter the attending physician’s name.
• Supervising Physician NPI: Enter the attending physician’s NPI.