WPPA ProviDRs Care Network has formed a program called the
PROVIDER
EDUCATION
PROGRAM to assist physicians, hospitals, facilities and their staff in filing a claim appropriately.
The following information is provided to answer common claim and ID card questions
and to assist in identifying which information is necessary for WPPA ProviDRs Care
Network to reprice the claim and forward it on to the appropriate Payor.
If a provider has utilized this information but needs further assistance, please contact our Claims Department
to schedule a PEP Rally via telephone or on-site. To contact us, call
toll-free (800) 801-9772 or local (316) 683-4111, or feel free to email Jeanne Hingst, Claims Coordinator at JeanneHingst@ProviDRsCare.Net.
The sections below address common questions and issues when filing a claim with
WPPA ProviDRs Care Network. To view, click on the section for more information.
+ How to identify WPPA ProviDRs Care Network as the PPO Network
One of the following logos on an ID card identifies WPPA ProviDRs Care Network as
the PPO:
If the ID card does not reflect either of the above logos, please review the card
for the accurate network information. If you need assistance in identifying
the patient's network, please contact the Insurance company directly. Their
telephone number should be available on the ID card.
+ Identify the Payor from an ID card
WPPA ProviDRs Care Network is not an Insurance company; we are a PPO Network.
Please refer to the patient's ID card to identify the Payor. On the sample
ID card below, Assurant Health is the Payor.
+ Cross reference ID card information to corresponding HCFA claim boxes
You've seen our logo on your patient's medical ID card and that means that they
have selected WPPA ProviDRs Care Network as their Preferred Provider Network! Each
and every claim must be submitted with some very important information that you
can get from your patient's ID card...let's take a look at where this information
can be found and where it should go on a HCFA claim. Remember...If you're
an office putting information from an ID card for your billing company, this information
is important to you also:
+ Cross reference ID card information to corresponding UB claim boxes
You've seen our logo on your patient's medical ID card and that means that they
have selected WPPA ProviDRs Care Network as their Preferred Provider Network. Each
and every claim must be submitted with some very important information that you
can get from your patient's ID card...let's take a look at where this information
can be found and where it should go on a HCFA claim. Remember...If you're
an office putting information from an ID card for your billing company, this information
is important to you also:
+ Filing a claim with professional
fees for anesthesia
When billing for anesthesia, whether filed on a HCFA or UB claim, the CPT Code and
minutes are required in order to reprice the claim. Please supply both of
these components for each anesthesia service billed. If these components are
not provided, the claim will be returned in order to supply WPPA ProviDRs Care Network
with the required information. The following is one example of where this
information can be provided on a claim.
+ Filing an institutional claim
with professional fees
When billing a UB claim with professional fees, the CPT Code for the service is
required in order to reprice the claim. Please supply this component for each
professional fee billed. If this component is not provided, the claim will
be returned to you in order to supply WPPA ProviDRs Care Network with the required information.
The following is one example of professional fees billed on a UB claim.
+ How to know if the patient is still participating in the WPPA ProviDRs Care Network
Our enrollment information is limited to employer group names and individual policy
holders. To verify if a patient is enrolled with WPPA ProviDRs Care Network, review the most recent ID card and contact the telephone number listed for benefits
and/or eligibility. This information may also be found on the Payor's website
(when available).
+ How do I file claims electronically to WPPA ProviDRs Care Network
WPPA ProviDRs Care Network is teaming up with Legacy Consulting AdminsTEP to enable
providers to submit claims electronically. To find out how to submit your
claims electronically, please see our updated list of EDI vendor connections on
our News Page. You may also contact one of AdminisTEP's Provider Enrollment Representatives
at (888) 751-3271 Ext 3141 or go to www.adminisTEP.com.
+ ACC / Chiropractors Filing Claims
WPPA ProviDRs Care Network contracts our participating chiropractors based on the
Affiliated Chiropractic Care (ACC) Network participants. Chiropractors should
submit their claims according to ACC standards. Claims cannot be repriced
unless these standards are met. >>Click
here to contact ACC
