Our Capabilities

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What We Do

Since 1946, we’ve earned countless accolades for our capabilities and they’ve grown with each passing year. It’s never been enough for us to be satisfied with our past successes or settle for our past capabilities.

With every claim and every year in service, our company and workforce has become more qualified and experienced. This is how WPS is able to deliver dependability and quality assurance to all the federal government contracts we support.

Through more than 75 years and millions of claims, we've proven ourselves to be an effective, efficient, and responsive claims processor. We have the technology, staff, and expertise to consistently beat deadlines and exceed quality requirements.

We handle all claims administration functions, from processing claims to program management, eligibility verification, provider services, financial services, third-party liability, and Medicare Secondary Payer services.

We process 214.5 million claims and make $62.1 billion in payments each year. In all, WPS serves more than 7 million Medicare beneficiaries, 9 million active-duty military, veterans, and their families, and more than 55,000 Wisconsin residents who are in a Wisconsin Medicaid Long-Term Care program.



  • Processing capability of 7.8 million claims per month across multiple contracts
  • Make $62.1 billion in payments each year
  • 98% average auto-adjudication rate


  • Integration with the Defense Health Agency (DHA) Defense Manpower Data Center (DMDC) and Centers for Medicare and Medicaid (CMS) core administration systems
  • Capable of integrating with external Application Programming Interfaces (APIs) and providing standardized APIs for interconnect to WPS systems


  • HIPAA X12 standards compliant
  • National Institute of Standards and Technology (NIST) compliant


  • Domain specialists dedicated to developing solutions that meet customer requirements and reflect changes in regulatory requirements
  • Use of Agile and waterfall methodologies to support iterative solution delivery and reduce time-to-market
  • Extensive track record in achieving industry benchmarks and meeting rigorous compliance standards

WPS makes health plan choice and participation easy for government employees by ‘‘connecting the dots’’ quickly and accurately with fully secured enrollment and premium payment capabilities. Supported by a sophisticated rules engine, the system efficiently handles enrollment modifications driven by changes in beneficiaries’ life circumstances, employment status, or health plan design.

Fully compliant with federal requirements, the enrollment system is integrated with the Defense Enrollment and Eligibility Reporting System (DEERS). It also readily supports integration with targeted systems of record and prime contractor central administration systems.



  • Defense Enrollment and Eligibility Reporting System (DEERS) integration, including the Beneficiary Web Enrollment (BWE) system, simplifies processing, reduces errors, and improves beneficiary experience
  • Defense Manpower Data Center (DMDC) integration simplifies data request responses and report tracking


  • Multiple payment options for one-time and recurring payments, including credit card, ACH, allotment, and check


  • Inbound and outbound processing controls ensure all records received are processed timely
  • Customizable reports to identify errors quickly and handle them cost-effectively

Technical Data

  • Policy Notification Transaction (PNT) capacity up to 60,000 per hour
  • RESTful APIs available for all standard transactions
  • Provide outsourced Payment Card Industry (PCI) compliant payment services
  • HIPAA X12 standards compliant

As a Medicare Administrative Contractor, WPS uses the Centers for Medicare & Medicaid Services (CMS) Integrated Data Repository (IDR). WPS' data analytics and health informatics team leverages IDR data to support our claims processing and medical review functions.

WPS has robust data integration capabilities which support the Centers for Medicare & Medicaid Services (CMS), Defense Health Agency, and commercial customers. These best-in-class capabilities process hundreds of millions of transactions annually, while vastly exceeding HIPAA transaction national standards. WPS’ secure self-service electronic data interchange (EDI) portal provides rapid file transfer capabilities, while enabling your organization’s data to be used to meet processing and compliance needs.

WPS’ Business Process Outsourcing (BPO) leverages best-in-class equipment, software, and processes to provide efficient, highly scalable, inbound/outbound mailroom, and optical character recognition services (OCR) for clients seeking to reduce costs and focus on their core business processes.

WPS’ BPO solution offers you cost-effective, secure, and compliant services for government and non-government clients. WPS BPO includes inbound mail correspondence, paper to electronic data interchange (EDI) medical and dental claims conversion, and outbound explanation of benefits (EOB) print and mail services.


  • Secured location set-up and controls environment for handling sensitive data
  • Long-term storage of federal records
  • Reliable back-up and recovery capabilities
  • HIPAA and Health Information Trust Alliance (HITRUST) compliant

Technical Data

  • Scanning, optical character recognition (OCR), and automated classification of documents
  • Print services
  • Inbound and outbound mail

WPS takes our role in protecting health and financial information seriously. We’ve earned the confidence of providers, beneficiaries, and government customers by ensuring both the integrity and availability of our services and systems. Serving a variety of state and federal government agencies requires a robust and auditable security and privacy program that ensures compliance against varying frameworks. Our platform supports evolving, onboarding, and sunsetting of individual controls and entire frameworks, a maturity we bring along with all our products or as a consulting service for your products and systems.

WPS has shown the ability to effectively develop, execute, monitor, and revise the Medical Review Improper Payment Reduction Strategy (IPRS) to prevent inappropriate claim payments. The structure of our Medical Review Management team provides both strong clinical and operational support.

With decades of Medicare experience across several departments, the Medical Review Clinical Management and Operational Management teams bring nuance to medical review. WPS uses technology to increase efficiency, improve quality, and reduce costs. We’re always looking for ways to innovate and improve our medical review processes.

The experienced Customer Service team at WPS ensures accurate, timely, and accessible program information is provided to our Medicare and Military and Veterans Health beneficiaries.

We’ve made health care easier for customers by making data available 24/7, easing the burden on providers.

To achieve our goals, we have a four-point strategy:

  1. Know and listen to our customers.
  2. Develop material to effectively meet customers’ needs using technology, processes, and people.
  3. Administer a quality program.
  4. Use technology to provide self-service tools and manage relationships.

WPS has enrolled providers in Medicare for decades. WPS performs enrollment, rejection, denial, change of information, and revalidation for approximately 150,000 provider enrollment applications annually.

WPS has nearly 2,700 employees, including an experienced provider enrollment staff. Our experts can provide research on a wide array of sources, including Provider Enrollment, Chain, and Ownership System (PECOS), Office of Inspector General, SAM.gov., various state licensure websites, and supporting documentation for Adverse Legal Actions.

We interact with CMS staff daily to complete administrative actions on enrollment or referrals to the agency for further action.

Our knowledgeable and experienced provider audit and reimbursement team annually processes thousands of cost-report acceptances, desk reviews, and reopenings, creating efficient workflows from system to system.