Resources
- Authorization Request Form for COBA/Medicare A or B Primary Product or Service
- Claim Appeal Submission Form
- Claim Payment Appeals Process
- Corrected Claim Form
- Corrected Claim Form Tip Sheet
- EFT Agreement
- EFT Instructions
- ERA Agreement
- ERA Instructions
- Family Care Claim Explanation Codes
- Family Care Claim Form Outline
- Family Care Claim Submission Tips
- Family Care/WPS General Claim Submission Requirements
- Inclusa Covered and Non-Covered OTC Products and SME
- MOVEit Instructions for Excel Submissions
- Paper Claim Form
- Provider Billing Facts for Electronic Visit Verification (EVV)
- Provider Nursing Home Authorization Information
- Provider Refund Request for WPS
- Residential Types of Bill
- Transportation Claim Example Form for AFH
- WPS EFT Tip Sheet
- WPS Spreadsheet Submitter Internet Agreement
- Z-Code Packages 2020
- Z-Code Packages 2020 Summary
Contact Information
Transportation & Employment Support Team
- Adult Day Care
- Vocational Futures Planning & Support
- Daily Living Skills Training
- Day Habilitation Services
- Pre-Vocational
- Supported Employment
- Transportation (All)
Email: ACS-Transportation-Employment@inclusa.org
Phone: 1-888-544-9353, Option 4
Fax: 608-785-5335
DME/DMS/OTC Support Team
- Adaptive Aids
- Communication Aids
- Disposable Medical Supplies (DMS)
- Durable Medical Equipment (DME)
- Environmental Accessible Adaptations (Home Modifications)
- Over-the-Counter Medications (OTC)
- Vehicle Modifications
Email: ACS-DME-DMS-OTC@inclusa.org
Phone: 1-888-544-9353, Option 5
Fax: 608-785-5335
Residential/CSL/NH/Therapy Support Team
- Alcohol and Other Drug Abuse Treatment
- Alternative Therapies
- Community Support Program (CSP)
- Community Supported Living (CSL)
- Counseling & Therapeutic Resources
- Mental Health Services
- Nursing Homes
- Occupational Therapy
- Physical Therapy
- Residential Care (AFHs, CBRFs & RCACs
- Respite Care
- Speech Therapy
Email: ACS-Residential-CSL-NH-Therapy@inclusa.org
Phone: 1-888-544-9353, Option 6
Fax: 608-785-5335
SHC/SDS/Home Health Support Team
- Case Management – External
- Consultative clinical/ therapeutic services for caregiver
- Consumer Education and Training
- Emergency Assistance to obtain/retain a home
- Financial Management Service (Rep Payee)
- Home Delivered Meals
- Home Health Care
- Home Health Care – Home Health Aide
- Home Health Care – Nurse
- Housing Counseling
- Non-covered MCO Services (Out of Benefit)
- Occupational Therapy-Home Health Care
- Personal Care/Agency
- Personal Emergency Response Systems
- Physical Therapy-Home Health Care
- Self‐Directed Supports (SDS)
- Skilled Nursing-Home Health Care
- Skilled Nursing Service – Independent/Private
- Speech Therapy-Home Health Care
- Supportive Home Care
- Support Broker
Email: ACS-SHC-SDS-HomeHealth@inclusa.org
Phone: 1-888-544-9353, Option 7
Fax: 608-785-5335
Audit & Appeals
- Provider Audits
- Provider Appeals
Email: providerclaimappealandaudit@inclusa.org
Phone: 1-888-544-9353, Option 8
Fax: 608-785-5335
WPS Provider Customer Support
WPS / Family Care Contact Center
1-800-223-6016 (8:00 a.m. – 4:30 p.m., M-F)
- General claims support questions
- Claim and payment status
- WPS Inclusa Paper Claim Form
WPS EDI Help Desk
1-800-782-2680, Option 1
- Online registration issues, password resets, login assistance
- Missing files or other technical concerns
- Validating claim acceptance by EDI/EDI rejection message assistance
(rejected by EDI, not denied by WPS)
WPS EDI Marketing
1-800-782-2680, Option 2
- Assistance with enrollment for claims submission, electronic remittance, and direct deposit (EFT)
WPS Website
- Visit WPS/Inclusa Website
- Forms, instructions, and support related to options for claims and payments