Licensure Board

WPS Announces New Prepay Edit

Wisconsin Physicians Service (WPS) announced on April 17, 2017 the initiation of a new prepay edit for complex medical review of Part A inpatient SNF claims in the J5 Jurisdiction. The J5 Jurisdiction includes the states of Iowa, Kansas, Missouri and Nebraska as well as assigned National Providers. WPS completed recent prepay Part A audits under the previous edit (50SNF). This new edit is identified as 51SNF (this will be the reason code listed on the ADR request) and will continue to target claims billed at an RU RUG.

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