WPS Military and Veterans Health is preparing to make changes to our EDI front-end editing for TRICARE East Region 837 Professional claims. Currently, many claims pend within the claims processing system because they were submitted with an incorrect Billing Provider Name and/or National Provider Identifier (NPI), or the rendering provider segment is missing when a clinic submitted the claim.
To allow our trading partners time to implement changes, WPS will be providing notices until an implementation date has been determined for the new edits. WPS will be using the National Plan and Provider Enumeration System (NPPES) as the resource for validating NPI data, therefore it is important that provider’s review their NPPES records for accuracy.
The following edits will be applied to 837 Professional claims only:
You will be notified again when WPS has determined a formal implementation date for these Billing/Rendering provider changes.