WPS MEDICARE AUTHORIZATION FORM FOR ELECTRONIC REMITTANCE ADVICE ERA TUTORIAL

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WPS MEDICARE AUTHORIZATION FORM FOR ELECTRONIC
REMITTANCE ADVICE (ERA) TUTORIAL
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Tutorial for completing a Medicare ERA
Authorization Form

• This tutorial is designed to walk you through the
  process of completing the Medicare ERA
  Authorization Form.
• The form must be completed correctly and legible
  in order to be processed. The following
  presentation will assist you in completing the
  application correctly.

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What you need to know before you begin

• You can obtain your ERA file several ways. A
  Clearinghouse, Billing Service, or Third Party
  Company can obtain the files on your behalf. You
  can download the file from our Bulletin Board
  System (BBS) using a 5 digit submitter ID number.
  You may also use a connectivity vendor such as
  Ivans or Visionshare. Connectivity vendors allow
  an alternative method to connect with the
  contractor to receive ERA files.
• IVANS www.ivans.com
• VISIONSHARE www.visionshareinc.com
• CMS offers FREE software, Medicare Remit Easy
  Print (MREP) for Part B providers, and PC Print
  for Part A providers which will convert the ERA
  file to a readable and printable format.
• Changes made to an ERA set up for Medicare Part B
  providers will prompt remits to be generated
  paper for 45 calendar days, in addition to the
  ERA file.
• Part A Providers who are a new set up only will
  receive paper EOBs in the mail for 30 calendar
  days.

• The ERA Authorization form can be located at the
  following web address
• http//www.wpsic.com/edi/pdf/edi_ernmedb.pdf
• The form can be completed on the website and
  printed out for a signature.
• For more information or further assistance,
  please contact your Helpdesk.
• Medicare Legacy B EDI Hotline (WI, MI, MN, and
  IL) [phone]
• Medicare Part A B J5 EDI Hotline (MO, IA, KS,
  NE) [phone]
• Medicare Legacy Part A (institutional providers
  who joined WPS in October 2007)
• (866)-734-6656

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• If the form is received as not legible or not
  completed correctly, it will be returned to the
  provider for correction.
• The request may take up to 14 business days to
  complete.

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• New Submitter or Add Providers
• The NEW SUBMITTER or ADD PROVIDERS portion of the
  form applies ONLY to Part A providers.
• Check all lines of business that apply (based on
  the state where the services are being rendered)
• Part MAC J5 A or B (IA, KS, NE, MO)
• Part B Legacy (IL, MI, MN, WI)
• Part A Legacy (multi-states, institutional
  providers who joined WPS in October 2007)
• Please identify the company that will be
  retrieving the ERA files
• Provider/Physician This is when you have
  obtained a 5 digit Submitter ID number issued by
  the EDI Dept or through self
• registration on our website and will be
  downloading your ERA files through the Bulletin
  Board System (BBS) (this includes
• Providers utilizing IVANS/Visionshare)
• Corporate Office This is when the Corporate
  Office (generally seen with large facilities) has
  been issued the 5 digit
• Submitter ID number and will be obtaining and
  dispersing the ERA files within their
  corporation.
• Third Party Company/Clearinghouse This is when
  another party (clearinghouse, billing service)
  will have obtained the
• 5 digit Submitter ID number and will be
  retrieving the ERA files on your behalf. You
  will get your ERA files from the Third
• Party Company, Billing Service, or Clearinghouse.

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• This section of the form should contain the
  PROVIDERS information ONLY.
• -Provide the name, address, city, state and zip
  of the billing provider.
• -You must provide the address that is on file
  with Medicare Provider Enrollment. If the
  address
• provided on the form does not match the address
  we have on file, the form will be returned for
• correction.
• -Provide a contact persons name, email address,
  fax, and phone number.
• WPS SUBMITTER ID
• This is the number that has assigned to whomever
  is sending the claims. If you are utilizing a
  Third Party Company,
• Billing Service, or Clearinghouse to send on your
  behalf, you may need to contact this entity and
  request the Submitter
• ID number. All WPS issued Submitter ID numbers
  are 5 digits. Part B Missouri East providers
  ONLY may
• also use an alpha numeric Submitter ID. (IE
  MO123)

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• Provider Name
• This would be the provider name on file with
  Provider Enrollment. For Part B providers, if
  the individual
• provider is a member of a group or has more than
  one NPI number (Group NPI and Individual NPI), it
  will
• be the group name that needs to be provided.
• NPI Number and Provider Number (AKA Pin,
  Legacy, Provider Number, Oscar, and Group Number)
  
• For Part B providers, if you are enrolled as an
  individual within a group or have more than one
  PTAN/NPI
• number, the numbers provided on the form MUST be
  the Group or Clinic numbers. For Part A
  providers, all
• NPI numbers associated with the provider number
  must be given.
• Multiple Group or Facility Numbers can be listed
  on the form if they share the same address
  information.

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• All providers must include both a signature and
  effective date for
• this request to be processed.
• Provide a signature from an authorized
  representative for the provider, printed name,
  and date you want to begin receiving ERAs.
• Do not send the form with an effective date
  greater than two weeks from the date sent to EDI.
  
• (If the effective date is greater than two
  weeks from the date sent to EDI, the form may be
  returned to you.)
• Who is authorized to sign?
• This is a contract. As long as you are
  authorized to put the provider
• into a binding contract, you may sign the form.

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• This section of the form should ONLY be completed
  if someone such as a
• Billing Service, Clearinghouse, or Third-Party
  Vendor will be sending claims
• on your behalf.
• Place and X in the box authorizing the Third
  Party Company, Billing Service
• or Clearinghouse to send on your behalf.
• All providers must include both a signature and
  effective date for this
• request to be processed.
• Provide a contact persons name, email address,
  and phone number from the entity receiving ERA on
  your
• behalf. (the providers contact information would
  be provided in the top portion of the form)

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• MREP (Medicare Remit Easy Print)
• This software is specifically designed for
  Medicare Part B providers ONLY. The download can
  be found at the following web address..
• http//www.cms.hhs.gov/AccesstoDataApplication/02
  _MedicareRemitEasyPrint.asp
• PC PRINT
• This software is specifically designed for
  Medicare Part A providers ONLY. The download can
  be found at the following web address..
• http//www.wpsmedicare.com/part_a/business/pc_pri
  nt.shtml

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• Once the agreement is completed, it can be
  returned to the appropriate Help Desk via Fax or
  Mail.

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This Concludes the Tutorial.