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Government Solutions


WPS Health Solutions' modular and integrated technology handles the full experience of health plan benefits from navigation and enrollment through claims administration and care management—all delivered on a compliant, secure, and interconnected platform. Integration is available to all federal and state agencies through a standardized connection library.

WPS makes benefit plan enrollment and participation easy for government employees and citizens alike by “connecting the dots” quickly, accurately, and in a compliant manner, using leading back-office capabilities we’ve built over 75 years in business.

Grounded with a solid federal compliance program, core claims administration, and information and workflow management for government customers at scale, WPS has experience supporting a wide spectrum of beneficiaries from TRICARE, Department of Veterans Affairs, Medicare, and Medicaid to commercial members and other health insurance providers.

Government Contracting Experience

  • Administering foreign medical claims for the TRICARE Overseas Program
  • Processing more than 750,000 claims annually for nearly 550,000 beneficiaries
  • Paying more than $330 million in benefits annually
  • Providing multilingual customer support call center for both overseas providers and beneficiaries
  • Processing TRICARE claims
  • Offering customer service, supporting providers, and responding to questions and concerns with billing and enrollment
  • Coordinating Managed Care Support Contractor and Defense Manpower Data
  • Verifying beneficiary eligibility via Defense Enrollment Eligibility Reporting System (DEERS) interface
  • Submitting TRICARE Encounter Data (TED) records
  • Serving 6 million beneficiaries (two out of three in the TRICARE population) while processing 45.1 million claims and paying $9.5 billion in benefits per year
  • Processing claims for TRICARE-eligible beneficiaries who have Medicare Part A and B coverage
  • Providing high-quality customer service to beneficiaries and health care providers
  • Maintaining full-function beneficiary and provider portals for 24/7 self-service access to claims, program information, and educational materials
  • Coordinating with the Defense Manpower Data Center for Defense Enrollment Eligibility Reporting System (DEERS) interface
  • Submitting TRICARE Encounter Data (TED) records
  • Preserving effective cost containment through medical review and program integrity units to ensure reimbursement of medically necessary services and covered benefits
  • Serving 2.34 million beneficiaries annually while processing 57.3 million claims and paying $4.2 billion in benefits
  • Subcontracting on a 10-year, $1 billion contract vehicle for professional consulting and health care services covering health system transformation and innovation, implementation and operations support, and health care business-enabling services
  • Managed veterans' PC3 claims, initially for three regions serving 750,000 beneficiaries while processing 4 million claims and paying $1 billion per year, and then for the entire nation during the transition to Community Care Network
  • Served approximately 1.5 million CCN beneficiaries
  • Received, processed, adjudicated, and paid provider claims for 13 states over the western United States
  • Enrolling providers in four states as well as additional Medicare Part A providers in 47 states
  • Delivering customer service
  • Processing claims and appeals
  • Performing medical reviews, provider audits and reimbursements, and data analytics
  • Serving 4 million beneficiaries and 67,000 providers annually and processing 65 million claims while paying $30 billion in benefits
  • Enrolling providers in two states
  • Delivering customer service
  • Processing claims and appeals
  • Performing medical reviews, provider audits and reimbursements, and data analytics
  • Serving 3 million beneficiaries and 78,000 providers annually, processing 61 million claims while paying $17 billion in benefits

   

Government Seals

NAIC Codes

NAIC is the standard classification system used by federal agencies that classifies the type of work the business performs.

  • 524114—Direct health and medical insurance carriers
  • 524292—Third-party administration of insurance and pension funds
  • 541611—Administrative management and general management consulting services
  • 541990—All other professional, scientific, and technical services
  • 541690—Other scientific and technical consulting services
  • 561110—Office administrative services
  • 524210—Insurance agencies and brokerages
  • 541211—Offices of certified public accountants
  • 541219—Other accounting services

Note: Beneficiaries and annualized claims estimated and rounded as of Dec. 31, 2022.