Government Services

WPS, a health solutions company's 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 nearly 80 yearsin 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

Prime Contracts

TRICARE For Life: TRICARE Medicare Eligible Program (TMEP)

• 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

Jurisdiction 5 Medicare Administrative Contractor

• 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

Jurisdiction 8 Medicare Administrative Contractor

• 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

Subcontracts

TRICARE Overseas Program (TOP)

• 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

TRICARE East Region Managed Care Support Contractor (MCSC)

• 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

VHA Integrated Healthcare Transformation (IHT) IDIQ

• 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

Patient-Centered Community Care (PC3) and Choice Programs All Regions

• 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

VA Community Care Network (CCN) Region 4

• Served approximately 1.5 million CCN beneficiaries
• Received, processed, adjudicated, and paid provider claims for 13 states over the western United States

   

WPS Milestones

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Classifications Supported by WPS

DUNS: 086684339
CAGE: 2R921

NAIC Codes

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

• 524210—Insurance Agencies and Brokerages
• 524291—Claims Adjusting
• 524292—Third Party Administration of Insurance and Pension Funds
• 524298—All Other Insurance Related Activities
• 541211—Offices of Certified Public Accountants
• 541219—Other Accounting Services
• 541611—Administrative Management and General Management Consulting Services
• 541618—Other Management Consulting Services
• 541690—Other Scientific and Technical Consulting Services
• 541990—All Other Professional, Scientific, and Technical Services
• 561110—Office Administrative Services
• 561421—Telephone Answering Services
• 561431—Private Mail Centers
• 561439—Other Business Service Centers (including Copy Shops)
• 561499—All Other Business Support Services

Note: Beneficiaries and annualized claims estimated and rounded as of Dec. 31, 2024.