TriWest Web Site Makes Online Functions More Efficient for Providers
In an effort to make accessing information on www.triwest.com quicker and more convenient for providers as well as helping improve business office workflow and productivity for their staff, TriWest Healthcare Alliance Corp. and its claims processor Wisconsin Physicians Service (WPS) have improved the online features in the secured Web site at www.triwest.com.
The "instant registration" feature on TriWest’s Web site allows providers to register online to use www.triwest.com’s secured provider portal and receive an e-mail containing a link to authenticate their registration immediately. Once registering providers are authenticated, they can gain immediate access to the secured portal.
How Does Instant Registration Work?
It authenticates registering providers by verifying data already contained in our system through claims on file with WPS. During
registration, providers and/or their staff members must provide two patients’ "internal control numbers" as indicated on Explanation
of Benefits (EOB) forms, as well as those patients’ dates of birth. If this information can be authenticated, an e-mail is automatically
sent to the registering user so that he or she can activate the account and immediately begin accessing the tools and information
contained in the provider section. If the provider does not have a claim on file, instant registration cannot be completed and he
or she will receive a password by mail as in the past.
Registration for this portal on www.triwest.com allows providers to:
- Check patient eligibility
- View patient benefit information
- Check referral/authorization status
- Review and update consult tracking feedback reports
- Submit claims and check status online
Filing Claims: Electronic Data Interchange (EDI)
WPS staff is skilled in implementing EDI strategies with a variety of provider specialties, billing services, and software vendors.
Choosing one of their electronic data interchange (EDI) options assures you ample assistance throughout the claims filing process.
The EDI edit systems are designed to minimize data entry errors before claims are passed to the WPS processing system.
EDI claims are generally processed and paid very quickly. Currently, claims are being processed within the following timeframes:
- 71% of clean claims submitted online are processed immediately (a clean claim does not contain a defect requiring investigation or development prior to adjudication)
- 97% of clean claims submitted online are processed in 15 days or less
- 99.7% of all clean claims are processed in 30 days or less
Internet Claim Submission
You may choose Internet claim submission. Professional and hospital providers can enter and submit TRICARE claims online over a secured
Web site (www.triwest.com) and receive an immediate processing response. The claim entry screens have been designed to contain
only the data that TRICARE requires for claims processing.
Vendor, Clearinghouse, or Billing Service Option
You may choose an EDI software program from a vendor, clearinghouse, or billing service whose software already has been approved
for TRICARE electronic claims submission.
EDI Software Option
You may choose an EDI software option provided by WPS. WPS claim entry software provides a stand-alone solution that creates a patient
database and allows claim entry and claim transmission to WPS. WPS’s print-file software converts print-image claim files from a practice
management system into an electronic format for submission to WPS.
WPS EDI Contact Information
You may contact WPS by phone, fax, mail, or e-mail for information about electronic claims. WPS staff can assist you in determining
the best option for your EDI needs.
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Phone |
1-800-782-2680 |
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Fax |
1-608-223-3824 |
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WPS Electronic Data Services |
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Web site |
Another Time-Saving Feature – Electronic Remittance Advice (ERA)
The Electronic Remittance Advice (ERA) can help improve a provider’s business office workflow and productivity. Now available through
WPS, the ERA can be automatically loaded into a provider’s accounts receivable system depending on their software. ERA can be a secure
and reliable alternative to manually posting claim adjudication information to an accounts receivable software program and allow providers
more time to focus on caring for their patients.
How Does It Work?
Containing the same information on claim payment, deductible, and co-insurance, ERA is the electronic equivalent of the EOB
and provides details on how your claims were paid and/or why they were denied. As soon as your WPS TRICARE claims finalize, WPS generates
your ERA.
What are the benefits of ERA?
Depending on the provider’s practice management system and internal workflow, ERA can improve a provider’s business office workflow
and productivity by:
- Eliminating the need to manually enter and process paper EOBs
- Eliminating errors associated with manual posting of paper EOBs
- Eliminating the need to store and file paper EOBs
- Decreasing the time spent reconciling accounts receivable
To enroll, providers can download and complete the Electronic Remittance Advice (PDF) document located at www.triwest.com, Find a Form tab and mail it to:
WPS Electronic Data Services
P.O. Box 8128
Madison, WI 53708-8128
For additional information on registering for the secured provider portal, submitting your claims online, and signing up to receive ERA, refer to www.triwest.com, or call 1-800-782-2680 (EDI Help Desk).