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WPS Government Health Administrators

Marketing Plan

Table of Contents

o Marketing
o Trends
o Trends
o Market
o Strengths
o Weaknesses
o Opportunities
o Threats

o Marketing/Communications
o Market

Executive Summary
Wisconsin Physicians Service Government Health Administrators (WPS GHA)
processes claims as the Medicare Administrative Contractor (MAC) for Jurisdictions 5
and 8. They receive claims from providers who give Medicare services to
beneficiaries and process these claims. In addition, WPS GHA enrolls providers in
the Medicare program, provides trainings and educational materials for providers
and answers questions for providers about claims and appeals processing.
The Centers for Medicaid & Medicare Services (CMS) is the government entity that
chooses MACs for each jurisdiction (groups of states that all have about the same
number of Medicare claims per year.) CMS chooses MACs in a competitive process
between insurance companies.

This plan is intended to:

Define the current state of WPS relationship to CMS and Medicare

Explain WPS GHAs organization and communications

Outline tactical marketing efforts that will support WPS GHAs strategic objectives
Explain the steps WPS GHA will have to take to establish itself as a leading Medicare
Administrator and improve itself
WPS GHA is in the process of rebranding and identifying itself as a leader in
Medicare administration. Marketing is an integral component of this rebranding. In
order to excel as a Medicare Administrative Contractor (MAC), WPS GHA must
continue to support innovation, improve internal and external communications,
improve efficiency and execute rebranding.
Using marketing, WPS GHA can continue to excel as a MAC and gain positive
feedback from providers in their jurisdictions. CMS uses provider satisfaction and
efficiency of claims processing as their main criteria for selecting MACs, and
marketing can aid WPS GHA in being a leader in both of these areas.
Vision Statement
WPS GHAs goal is to advance the vision and mission of CMS.
WPS GHA has the goal of winning more MAC jurisdictions as well as improving itself
as a MAC for its current jurisdictions
CMS Vision: A high quality health care system that ensures better care, access to
coverage, and improved health.
CMS Mission: As an effective steward of public funds, CMS is committed to
strengthening and modernizing the nations health care system to provide access to
high quality care and improved health at lower cost.
Situation Assessment
WPS GHA administers Medicare claims for Medicare providers in Jurisdictions 5 and
WPS GHA is the MAC for Jurisdictions 5 and 8. The Centers for Medicare & Medicaid
Services (CMS) selects MACs to administer Part A and B of the Medicare program to
certain states and process all Medicare claims for these states. Medicare Part A
covers hospital care, skilled nursing facility care, hospice and home health services.
Medicare Part B covers medically necessary and preventative services. In addition,
MACs enroll health care providers in the Medicare program, educate providers on
Medicare billing requirements and answer provider and beneficiary inquiries. WPS
serves as the primary operational contact between the Medicare Fee-For-Service
program and the healthcare providers enrolled in the program in Jurisdictions 5 and
8. Jurisdiction 5 includes Iowa, Kansas, Missouri, Nebraska and national providers,
while Jurisdiction 8 includes Indiana and Michigan. There are 8 different companies
that serve as MACs for the 12 jurisdictions. When CMS originally determined
jurisdictions, they determined them based on claims volumes so each jurisdiction
would have a similar number of claims to process each year.
WPS GHA faces a range of challenges and opportunities. While WPS GHA is
respected by CMS and has a good relationship with them on many levels,

historically WPS has not always treated CMS like a customer or partner. As a result,
WPS GHAs ability to help shape the direction of new opportunities and capture new
business in the form of new contracts and workloads is limited. Determining who
will get the MAC contract is a competitive process between insurance companies. In
addition, the MAC jurisdictions that WPS currently has (Jurisdictions 5 and 8) will
eventually be consolidated (this is currently on hold), and WPS will have to compete
with the MAC in the jurisdiction it will consolidate with to keep the contract.
Maintaining their contracts with CMS as well as expanding and acquiring new
jurisdictions is a top priority for WPS GHA.
Internally, WPS GHA faces challenges with their processes, technology and
communication. The WPS GHA website is undergoing a redesign in order to fix the
problems that currently exist with its navigation and design. The lack of operational
technical staff knowledge and structure make claims processing less efficient, and
improving internal communications will help WPS GHA have a more streamlined,
responsive process.
Addressing these and other internal challenges will enable us to maintain our
current MAC contracts and help win additional contracts. One company can
potentially process up to 26% of the national Medicare claims volume per the CMS
contract award limitation that exists. WPS currently processes 10.4% of the national
Medicare claims volume.
WPS GHA does perform well as a MAC, exemplified by the feedback WPS GHA
receives from providers in their jurisdictions on the MAC Satisfaction Indicator
Survey (MSI) put on by CMS each year. Using the feedback we receive from CMS
and Medicare providers, we can continue to determine what WPS GHA is doing well
and improve our practices in order to maintain our status as a leading MAC.
This marketing plan is intended to determine how marketing can help WPS GHA
establish itself as a leading MAC, keep its current contracts and gain more
Marketing Purpose
Marketing can, and will, play a vital role in the following aspects:

Redefining the GHA brand to better define capabilities and overall identity
Understanding provider trends
Increasing awareness via media outlets
Defining our differentiators
Fostering a better relationship with the Centers for Medicare and Medicaid Services
Supporting the development of a new web portal
Becoming a leading Medicare Administrative Contractor
WPS GHA has the opportunity to position itself as a trusted brand that provides
efficient claims processing and outstanding customer service to customers near and
Marketing Priorities

Execute rebranding of WPS Government Health Administrators

WPS is in the process of a company-wide rebranding project, including
changing the names of several of its business units and re-determining the
overall brand structure.
o Name change: WPS Government Health Administrators was formerly
called WPS Medicare, which created confusion as Medicare is a
government health program that WPS administers. By changing the
name from WPS Medicare to WPS GHA, it better defines WPS GHAs
identity and relationship to the Medicare program.
o Tagline: formerly, WPS Medicare did not have a tagline. However, with
the implementation of rebranding, WPS GHAs new tagline is A
Nations Promise, Kept. This tagline reaffirms our commitment to
provide outstanding service to Medicare providers and beneficiaries,
and reflects our long relationship with Medicare.
o The WPS GHA brand attributes were identified by employees and
should become the basis of the WPS GHA brand:
Efficient: contains client costs through efficient operations
Customer focused: operates according to unique client needs
Innovation leader: sets the industry pace for technology and
Value-added driven: delivers extra value beyond client
Experienced: accumulates knowledge to inform best practices
In-touch: stays connected with customers and their values.

In order to establish WPS GHA as a leading MAC and present the most up-to-date
ideas to CMS, WPS GHA must use innovative technologies and become a thought
Currently, WPS GHA has outdated operational tools that prevent WPS GHA from
getting CMS the data they need. WPS GHA should use tools and databases that
allow them to get information to CMS quickly.
WPS GHA uses many individual MACROs that require a lot of manual maintenance
time, and the systems do not work well with programs trying to capture staff
WPS GHA is implementing OnBase, an inventory and business process management
system, in order to process claims more efficiently and database information
OnBase has proved successful with many companies across the country as well as
within the WPS Medicare divisions provider enrollment department
OnBase will replace Solution Suites, which is the current imaging and process
management software being used in WPS Medicare
WPS GHA will purchase, develop and customize the OnBase software to the needs of
the division. The process management software currently being used is outdated
OnBase will:
Automate many current mundane administrative tasks and reduce
error; such as with mail sorting and database entry
Improve the ability to quickly and easily share, manage and transfer
documents between staff and departments as information will be
easy to find

Allow claims to have status updates and move updates through the
claims processing stages, which will allow providers to see where
their claim is in the process
Log and categorize incoming documents so they are easy to find if
a provider calls to inquire or a claim must be found fast
Track applications and improve metrics as it will allow WPS GHA to
see how long it took for a claim to be processed
There are three other projects underway to aid in innovation:
o 1. Data integration
o 2. Work Force Optimization
o 3. Website/portal redesign
WPS GHA should strive to be initiators of system enhancements.

The main criteria that CMS looks at when determining MACs is the efficiency
at which a MAC processes claims.
WPS GHA must use the most efficient and cost-cutting practices.
Using OnBase will improve the efficiency of the WPS GHA division
Educating providers in our jurisdictions on claims will allow more claims to be
submitted correctly the first time, or for providers to recognize why claims
were denied without submitting an appeal. It costs much more to process an
appeal than to process a claim, so educating providers to the best of our
ability will cut costs
By improving efficiency, we will become the best value to the government

Internal communication
Internal communication in the WPS GHA division must be improved in order
to provide the best customer service
Employees must be educated on what WPS GHA does as a MAC, Medicare updates
and more so any questions providers may have can be answered.
WPS GHA should strive to increase communication between Medicare Part A
management and Medicare Part B management. CMS expects Part A/B units in MACs
to work together, and WPS GHA has not been doing this as effectively as they could.
Information should flow well between upper management and the rest of the staff in
order to improve customer service and general employee knowledge.
External Communication

WPS GHA must communicate with CMS and providers through their website and
social media presence in order to be more accessible and in tune with Medicare
The website redesign project will help the WPS GHA website become more
streamlined and easy to use for providers that need to submit claims. Since
providers prefer to submit claims online, improving the website will improve
providers satisfaction with WPS GHA

By implementing a social media strategy, WPS GHA will be more accessible than
ever to the entities that need us. WPS GHA can promote trainings, share links and
keep providers in tune with what WPS GHA is doing.
Market Trends
Trends specific to Centers for Medicare and Medicaid Services

CMS selects MACs as multi-state, regional contractors responsible for administering

both Medicare Part A and Medicare Part B claims. In the selection of MACs, CMS uses
performance based evaluation criteria to evaluate insurance companies. MACs
propose innovative and cost-effective solutions to Medicare claims processing
business operations.
CMS chooses companies to serve as MACs to administer Medicare Parts A & B,
which is what WPS GHA currently does for Jurisdictions 5 & 8, as well as companies
to process claims for Home Health and Hospice and Durable Medical Equipment.
CMS typically uses three criteria to choose which company will be the MAC for a
1. Contractor gives exceptional customer service to providers
2. Contractor uses innovative technology and is constantly striving to find
innovative solutions
3. Contractor is efficient and uses the lowest costs and is the best value to the
With the application of performance based evaluation criteria in the selection of
MACs, claim administration costs have decreased, which means that WPS GHA must
continue to find cost effective ways to process claims and answer provider inquiries.
MACs in the past have proposed innovative and cost effective solutions to Medicare
claims processing business operations- the best company wins the contract
Originally, there were 15 primary MACs serving majority of provider types, 4 MACs
servicing Home Health and Hospice (HH+H), 4 MACs servicing suppliers of durable
medical equipment (DME). Future vision: 10 primary A/B MACs, four of the 10 A/B
MACs serving HH+H providers, and four separate contract MACs serving DME
CMS uses Medicare Administrative Contractor Satisfaction Indicator results to
monitor MAC performance, monitoring trends, improving oversight, increasing
efficiency of the Medicare program.
Upcoming MAC awards will include Home, Health, Hospice workloads.

Trends specific to providers

In WPS GHAs survey of providers in Jurisdictions 5 & 8, providers indicated they
wished to see fewer acronyms, that it was hard to find policies they were looking
for, and that the re-certification process was difficult. Other survey results are
discussed later.
MACs have their own ways of getting feedback from providers, including town halls,
surveys, etc. WPS GHA administers surveys each month to gain provider feedback,
which is crucial to improving as a MAC.


Claims being processed faster is better, more efficiently

It costs around 85 cents/claim to process a claim now, the goal is to get it to be 64
cents/claim. To process an appeal, it costs about $2.50 for Part B and $30-$40
for Part A. Providers and WPS GHA would like to reduce the number of appeals. We
can do this by educating our providers so they get their claims correct the first time
or recognize why a claim was denied and are able to resubmit the claim fixing their
mistakes instead of submitting an appeal.
Providers submit around 97% of claims electronically, and most prefer to submit
The biggest indicators of provider satisfaction are:
Handling of provider inquiries
Handling of appeals
Provider enrollment
Claims processing
Providers value MACs that give outstanding customer service and are able to
answer their questions in a short amount of time, or one phone call.
Every year, CMS comes out with a MAC Satisfaction Indicator Survey. WPS earned
the highest scores of any MAC in overall provider satisfaction. The three primary
drivers of WPS satisfaction scores are Provider Inquiries, Appeals, and Provider
There are eight Medicare Administrative Contractors (MACs) for the twelve Medicare
Jurisdictions across the country. Jurisdictions were originally determined by
determining the claims workload of each state and dividing states into jurisdictions
equally. These companies were selected by the Centers for Medicare & Medicaid
Services to administer Medicare Part A and Part B claims in multi-state jurisdictions.
According to the CMS website, MACs serve as the primary operational contact
between the Medicare Fee-For-Service Program, enroll health care providers in the
Medicare program, educate providers on Medicare billing requirements, and answer
provider and beneficiary inquiries.
Below is a graph detailing the percentage of National Part A & B workload each MAC
does. In accordance with the contract award limitation, a single MAC can only
service 26% of the national Part A & B workload.

% Workload by MAC
% Workload by


Below is a map that shows which company is the MAC for each state. For example,
WPS is the MAC for Jurisdictions 5 and 8, which includes Nebraska, Iowa, Kansas,
Missouri, Indiana, and Michigan, so these states are in purple. Some companies (like
WPS) service more than one jurisdiction.


*Noridian Healthcare Solutions, LLC is the MAC for American Samoa, Guam and the Northern Mariana
*First Coast Service Options, Inc. is the MAC for Puerto Rico and U.S. Virgin Islands

Below are the percentages of the National Part A & B workload that each MAC
administers Medicare for.


% National Part A
&B Workload

# of Jurisdictions

CGS Administrators


1, consolidation on hold

Cahaba Government
Benefit Administrators,


1, consolidated

First Coast Service

Options, Inc.


1, consolidated

Palmetto Government
Benefits Administrators


1, consolidated

Wisconsin Physicians
Service Insurance


2, consolidations on hold


Noridian Healthcare


2, consolidated

National Government
Services, Inc.


2, 1 consolidated, 1 consolidation on

Novitas Solutions, Inc.


2, consolidated

Below are the logos and taglines of each MAC company.




CGS Administrators


Cahaba Government
Benefit Administrators,


First Coast Service

Options, Inc.

When Experience Counts

and Quality Matters

Palmetto Government
Benefit Administrators,


Wisconsin Physicians
Service Government
Health Administrators

A Nations Promise,

Noridian Healthcare

Providing High Quality

Administrative Services to
Medicare since 1966.


National Government
Services, Inc.

Novitas Solutions, Inc.


Target Market
WPS GHA processes claims for Jurisdictions 5 & 8. Our target market in these
jurisdictions are providers that administer Medicare services to beneficiaries. We
must provide outstanding customer service to these doctors offices as their
feedback is used by CMS to evaluate our performance and how we are serving our
jurisdictions. This customer service includes answering any and all provider
questions, providing trainings, and processing claims and appeals in a timely
CMS is also a target market because they are in charge of awarding MAC
Jurisdictions each year and we want them to view WPS GHA in a positive light.
Winning more MAC Jurisdictions leads to more claims processing for WPS GHA in
different states.
Jurisdiction 5

This fact sheet for Jurisdiction 5 shows the number of beneficiaries, physicians,
hospitals, and claims volume. So far in 2015, WPS has processed 21,756,523 claims
for Jurisdiction 5. By state:


Claims Processed















Claims Processed














Claims Processed















Claims Processed














J5 MSI Data
CMS administers the MAC Satisfaction Indicator to determine how satisfied providers
are with the service of their MAC. WPS GHA has data from the report released in
February 2014, the data is from the year 2013.

The overall MAC satisfaction score for J5 was 70, on a scale of 1-100. This is
the highest rating any MAC was given. It is four points above the current
federal government average of 66.
o Areas of strength: scale of 1-100
Professionalism of reps: 88
Timeliness of electronic claims: 86
Timeliness of paper claims: 84
Outreach and education activities: 83
Reps demonstration of expertise: 83
Claims processing: 81
Opportunities for improvement: scale of 1-100
Status on claim related issues being provided promptly: 78
Reps ability to provide accurate information: 77
Reps ability to direct callers to quality references: 76
Reps ability to do relatively well in one-call resolution: 75
Explanations of first level appeal decisions: 74
Adjustment/correction of claims under reopenings process: 72
Clarity of adjustment or denial explanations: 71
Highest impacts on providers satisfaction:
Handling of provider inquiries (2.3).
Claims processing (1.3).
Appeals (1.2).

Jurisdiction 8

This fact sheet for Jurisdiction 8 shows the number of beneficiaries, physicians,
hospitals, and claims volume. So far in 2015, WPS has processed 27,230,024 claims
for Jurisdiction 5. By state:


Claims Processed
















Claims Processed













J8 MSI Data
CMS administers the MAC Satisfaction Indicator to determine how satisfied providers
are with the service of their MAC. WPS GHA has data from the report released in
February 2014, the data is from the year 2013.

The overall MAC satisfaction score for J5 was 69, on a scale of 1-100. This is the
second highest rating any jurisdiction gave their MAC (WPS also received the
highest rating of any MAC for J5) . It is four points above the current federal
government average of 66.
Areas of strength:
Analyst professionalism: 85
Self-service portal: 84
EDI Helpdesk: 82
Outreach and Education activities: 82
Professionalism of reps: 82
Claims processing: 80
Opportunities for improvement:
Handling of provider inquiries: 77
Reps ability to direct callers to quality references: 75
Reps ability to do relatively well in one-call issue resolution: 75
Reps timeliness with callbacks: 73
Provider enrollment: 73
Reps ability to give consistent information on one topic: 69
Time to complete appeal process: 56


Highest impact on provider satisfaction:

Handling of provider inquiries (2.3).
Appeals (1.2).
Provider enrollment (1.0)

CMS and the government can be considered a cost effective target audience
because if WPS GHA develops a stronger relationship with CMS and the government
it could lead to potential business and access to more jurisdictions creating more
overall profit. However, we can only do this by becoming more efficient and
reducing costs in our claims processing. As stated earlier, CMS main criteria are
that the MAC gives exceptional customer service, uses innovative technology and
strives to find innovative solutions, and uses the lowest costs to be the best value to
the government. By treating CMS as a partner and showing them how WPS GHA
meets these criteria, WPS GHA can win more MAC awards.
Market Growth
Developing an even stronger relationship with CMS could win WPS GHA more MAC
Jurisdictions in the future. Its also important the WPS GHA continues to foster their
relationship with CMS so they can regain the jurisdictions they are currently
consolidating with.
Home Health and Hospice care workload MACS are also important to consider. WPS
GHA has never processed claims for these workloads but towards the future, they
should be considered highly. Some companies currently do Home Health and
Hospice workloads, but in the future each jurisdictions MAC will have to process for
Home Health and Hospice. WPS GHA must begin to learn about these workloads in
order to win the new contracts that will include these workloads.
Product Offering and Position
Medicare Claims Processing
WPS is the Medicare Administrative Contractor for Jurisdictions 5 and 8. Jurisdiction
5 includes Iowa, Kansas, Missouri, and Nebraska. Jurisdiction 8 includes Indiana and
Michigan. WPS GHA processes Medicare claims and is the primary contact point for
providers in these states. When a Medicare provider in Jurisdiction 5 or 8 provides a
service to a beneficiary, the provider (the doctor, nursing home, etc.) will submit a
claim for this service to WPS GHA. WPS GHA will process the claim. In addition, WPS
is responsible for answering any and all questions Medicare providers may have,
enrolling new providers in the Medicare program, and providing resources for
providers about Medicare claims and billing requirements. WPS processes about 1.4
million claims per day and has an appeal rate of about .03%.
In the past, CMS awarded contracts every five years in a competitive process.
However, legislation was enacted that extends MAC contracts to ten years, and CMS


interpretation and action on the new legislation is not yet available. CMS is
expected to release a request for information within the next few weeks to gather
feedback on the new environment.
The company that presents the best plan for claims processing and provider
interaction will win the contract for that jurisdiction. Both of WPS current
Jurisdictions have their consolidations on hold with other jurisdictions, Jurisdiction 8
will be consolidated with Jurisdiction 15 and Jurisdiction 5 will be consolidated with
Jurisdiction 6. Once consolidated, it is important that WPS holds onto their contract.
If WPS gains the consolidated districts, they will have 24.5% of the National Part A &
B workload, and one company can only have up to 26%. If WPS does not gain the
consolidated districts, we should compete with companies for other Jurisdictions.
WPS will compete with other companies for the MAC contracts by demonstrating
that we are innovative and the most efficient claims-processing company. In
addition, WPS will provide resources to providers that allow providers to easily
submit claims and gain any information they may need about Medicare and the
claims process.
For Jurisdiction 8, one of WPS jurisdictions, there is no word from CMS yet on their
plans in relation to the extension of MAC contracts to 10 years. The request for
proposal is scheduled to be released third quarter 2015, pending CMS action on new
WPS GHA should focus on gaining Jurisdiction 15, who they will eventually be
consolidated with. Jurisdiction 15 is the MAC workload for Ohio and Kentucky and
also serves Home Health and Hospice in the great plain states as well as a portion
of the Mid-Atlantic region. There was an anticipated award date of June 26, 2015,
but action from CMS is still pending. CMS did indicate they would adhere to the fiveyear contract for this Jurisdiction. The incumbent MAC for this jurisdiction is CGS
Administrators, with a contract end date of November 1, 2015.
Currently, WPS offers CMS Secure Net Access Portal (CSNAP) as the way
providers can submit claims. About 97% of Medicare provider claims are submitted
electronically, while others are submitted through mail. This website also offers a
user manual and help center. CSNAP allows providers to access claims status, enter
claims, check patient eligibility, and more. Improving this website will help WPS be
more efficient in claims processing and allow WPS GHA to be a trusted company
with the Medicare providers in our Jurisdictions. The look of the website is outdated
and it may be difficult for providers to navigate as of now. However, the look and
navigation of CSNAP as well as the WPS GHA website will be covered with the
rebranding effort and website redesign. The website redesign project will integrate
CSNAP and the WPS GHA website to create a more streamlined experience.
In order to take full advantage of technology and make claims processing more
efficient, WPS will be implementing OnBase for Jurisdiction 8. OnBase will allow
claims that are mailed in or sent electronically be sorted by data elements and put
into a system. This will reduce error in sorting. In addition, the information on the
claim will be indexed, so if a provider calls about the status of their claim, a
customer service representative will be able to easily look up the status of that
claim. In addition, the indexing of information will allow appeals to be auto-filled


when a representative is processing an appeal. The implementation of OnBase will

make WPS more efficient and ultimately cut costs. However, WPS GHA is still lacking
in the way of innovative technologies that make the division more efficient. There
are differences between the ways Part A and B claims are processed, and the
implementation of new technologies should hopefully get rid of these differences.
WPS also offers resources and trainings to providers in each Jurisdiction. However,
these trainings and resources are disorganized on the website and may take longer
than needed to access. Providing more direct trainings will allow WPS to become an
innovation leader and earn more CMS Medicare Administrators contracts. Other
MACs, such as Cahaba and First Coast, offer their providers a University, which is
one stop training for all providers. Offering a comprehensive, easy to use training
will allow providers in WPS jurisdictions to trust WPS and get all the information
they need. By earning the trust of providers, WPS will establish itself as a leading
MAC, maintain their current contracts, and gain more contracts. When WPS
adequately trains providers on how to file claims, efficiency is increased. Processing
a claim costs much less than processing an appeal, so WPS should offer exemplary
trainings so providers can either get their claims correct the first time they submit
them or be able to notice their mistake if a claim they thought should be accepted
gets denied.

More possible opportunities for growth:

Home Health and Hospice care workloads (will be included in upcoming MAC
Winning more MAC contracts
Continuing improving upon practices as a MAC
Getting Jurisdiction 15 contract award
SWOT Analysis

Strong reputation with providers we service as evidenced by our performance on
the MSI
In 2014, 130 Million claims were processed by WPS Government Health
Excellent benefits through WPS Medicare Companion. For example, durable medical
equipment, skilled nursing care, home health care services, chiropractic services, xrays, mammograms, and lab tests, etc.
No paperwork, fast automatic claims service
Online access and resources
Prompt friendly customer service
WPS GHA has a stronger claims processing system which brings in more revenue
OnBase will make claims processing more efficient
Only MAC to service national providers
Low appeal rates from providers
Very accessible with a fast response rate, You can expect an email back from GHA
always. (WPS Medicare Provider Testimonial Video)
Strong support system that has strong integrity. Theres a strong sense of
openness. (WPS Medicare Provider Testimonial Video)
Education system is strong (WPS Medicare Provider Testimonial)


The ability to dial the phone and answer a question was really helpful. (WPS
Medicare Provider Testimonial Video)
Feedback: Provider Outreach prepares reports of comments from providers each
CMS views WPS GHA as the strongest Audit Contractor (CMS asked WPS to be a
volunteer for the HIGLAS transition and HBO prior authorizations demonstration)
Improving relationship with CMS and fostering it
Weak or dated operational tools (such as human sorting of mail and outdated
database of claims that cant be easily accessed) makes it difficult to change things
quickly because manual resources involved are too intense.
Limited performance metrics and monitoring (CMS metrics are dated, its hard to
monitor percentage of inventory and number of claims processed)
Unused funds from CMS (funds are being returned to CMS rather than being used
towards technology)
Lack of innovation in skill sets, technology and innovation (technology has been the
same for the past 10 years; WPS GHA tend to take the approach if it isnt broken
then dont change it)
Lack of direct communication (individuals are discouraged from calling CMS without
approval or direction from their manager and internally people in WPS GHA arent
communicating well)
No experience handling Home Health Claims and Hospice. This is a significant
weakness since upcoming MAC awards will include Home Health and Hospice
Establish a better relationship with CMS to establish more business and profit for the
Develop business in other jurisdictions other than 5 & 8 to process more claims
Improve technology i.e. Medicare IT systems, databasing
Improvement of website and social media (needs to be more accessible)
Create more awareness for Government Health Administrators by attending CMS
conferences and hospital association events
Beginning to handle Home Health Claims and Hospice, so GHA receives a higher
MAC award
Competitors strong relationships with CMS/government
Competitors innovative technology
Other MACs communications strategies
Jurisdiction regulations and regulations on MAC workload
Losing current jurisdictions when consolidation occurs
Business Objectives
Five strategic goals provide focus for our teams in their efforts to achieve our vision
and execute our strategy:

Healthy Customer Relations: Be a top performing contractor, thought

leader and partner to CMS
a. Earning CMS confidence in WPS: Achieve top tier performance ratings


i. Measure, monitor, and react accordingly to resolve internally identified

b. Become a thought leader for CMS: Become a trusted advisor to CMS initiating
i. Develop relationship management plan
ii. Establish regular meetings with CMS decision makers
iii. Identify top three issues/initiatives within CMS and present a proposal to them in
our Baltimore office
iv. Facilitate relationship development between WPS, CMS, and new provider payment
models, i.e. ThedaCare
v. Develop platform modernization roadmap for CMS and collaborate on RFIs
(potentially in conjunction with SPARQ teaming partners)
vi. Secure outside government relations/business development resource with CMS/HHS
c. Promote WPS: Create awareness within CMS of what we are proud of
vii. Promote change orders implemented without additional funding or other
achievements to CMS
viii. Develop process to enhance the quality of the presentation of key deliverables that
go to CMS
d. Improve customer experience / self-service tools: Implement enhancements
to simplify provider/customer interactions
i. Enhance look and feel of both portal and website
ii. Enhance C-SNAP using integration framework and web content management
iii. Implement customer relationship management (CRM project)
Maximize Technology Proficiency: Develop a solid IT foundation built for longterm growth
a. Optimize Medicare IT systems: Capitalize on a technology environment that
provides the most business value while maintaining the most technical health
b. Implement productivity analysis initiative
c. Create operational IT strategy
d. Complete technology application rationalization
e. Expand OnBase workflow management system to all Medicare departments
f. Implement electronic document classification in the mailroom
g. Enhance electronic data extraction capabilities to promote automation
h. Implement integration framework
i. Develop data analytics capabilities


Fully Engaged Workforce: Encourage and follow through on new ideas from staff
to improve processes
Engage Medicare frontline staff: Encourage and follow through on new ideas to
improve processes from frontline staff
Align personnels skill level to specific workload
Assess and implement alternative and flexible work schedules and expand work at
home initiative
Develop a philosophy to establish clear, measurable goals for each associate and
implement those policies
Formulate a protocol for all external communication with CMS and partners




Enhance training programs: Improve training to all levels of Medicare staff

Perform skills assessments
Improve training provided to staff
Optimize turnover rate: More effectively manage employee performance to
address performance issues in a more timely manner
Track and trend turnover
Simplify and/or reduce divisional and department policy
Diversification: Diversify into new niches within HHS
Develop better understanding of CMS gaps: Provide CMS with solutions to
challenges with unsolicited proposals
See Become a thought leader for CMS initiative
Obtain other than A/B MAC contract: Within CMS and outside of CMS within
Monitor and respond to CMS (including CMMI) opportunities
Bid for specialized projects
Profitable Growth: Grow profitably in each of our segments to enable investment
for sustainability and innovation
Retain current MAC contracts: Successfully retain current MAC contracts (J5 &
See Health Customer Relationship, Maximize Technology Proficiency, and
Fully Engaged Workforce
Add MAC contract: Add an additional MAC contract to become the first MAC
contractor to be awarded three MAC contracts
Develop Home Health & Hospice strategy
Achieve competitive cost per claim: Continue to drive down cost per claim rates
to compete on MAC contracts
Implement Workforce Optimization
Maximize earned award fees: Demonstrates CMS confidence and appreciation in
Increase awareness with business teams of the importance of collaboration and
process improvement
Promote inter-MAC collaboration
Develop process for sharing award fee objectives
Identify initiatives and track progress toward achievement of award fee objectives
Maximize available funds: Utilize unused funds to build competitive advantages
Develop prioritized list of potential projects
Implement Deltek financial system
Implement financial reporting and distribution of contract fund usage projections
Identify opportunities to add to the existing MAC SOWs: Propose and secure
additional funds from CMS to perform additional workloads to address existing
CMS/MAC related challenges
Identify opportunities to assist CMS, i.e. case management, cost containment, etc.
Marketing/Communications Strategy
External Communication
Website Redesign


WPS GHA can set itself apart by offering a clean, efficient website that is easy to
use for providers, potential providers, and beneficiaries. WPS GHA is currently in the
process of remaking its website with the help of Base22 in order to reflect WPS
rebranding as well as improve user experience.
Base22s objectives with WPS GHAs website redesign are:
Develop a modern and responsive website design while aligning look and feel,
branding and navigation across provider websites
Develop an information architecture framework that establishes the foundation for
enhancing and maintaining the overall design integrity of the websites
Develop and go forward enterprise web technology strategy and deliver enterprise
web reference model to WPS
Some main themes that the websites of all MACs have are:
Resources for beneficiaries
About us page
Trainings and resources for providers
WPS GHA can set itself apart by offering a clean, efficient website that is easy to
use for providers, potential providers, and beneficiaries.
Resources for beneficiaries
The websites of MACs are not technically meant for Medicare beneficiaries (people
enrolled in the Medicare program), but rather Medicare providers who provide
Medicare-funded services to beneficiaries. However, most MACs have links and
resources for beneficiaries in case a beneficiarys search led them to the website of
the jurisdictions MAC. Most MACs direct beneficiaries to the
website, as that is where the general information for Medicare beneficiaries is.
WPS GHA current state:
WPS GHA links beneficiaries to from their People with
Medicare tab on the WPS Medicare website. WPS GHAs People with
Medicare tab has information, an FAQ, a link for beneficiaries to find a
doctor, and more. However, some of the information is hard to disseminate
and might be difficult to access for beneficiaries who are not very familiar
with Medicare. There are many tabs with long reports, when the information
could be presented in a more concise way. Making this information easier to
read and access could allow WPS to better serve Medicare beneficiaries
(some of whom may be looking for Medicare Supplemental Insurance or a
Prescription Drug Plan- which WPS Health Solutions sells.)


Other MACs:
Cahaba Government Benefit Administrators (MAC for Jurisdiction J) provides a
beneficiary tab, but makes the information condensed and easy for
beneficiaries to access. They do not have long reports that would be difficult
for beneficiaries to understand.

Recommendation: provide basic information about Medicare to beneficiaries with an

FAQ, but also link as much as possible to website on this tab as that is
where the easily accessible and readable information for Medicare beneficiaries
About Us Page


Since MACs are all insurance companies, their websites usually provide an About
Us page or paragraph on their homepage that explains what the company does as
a MAC. This allows providers in their jurisdictions to get to know the company that is
handling their claims, and makes the company seem approachable.
WPS Current State:
WPS GHA does have an About Us section. It explains what WPS does as a
MAC. However, it is not featured on the Medicare website home page and is in small
font on the bottom of the page. The actual page explains WPS history with
Medicare, which jurisdictions WPS GHA serves, and some important facts about WPS
as a MAC, such as its ratings in satisfaction surveys.

link to About Us page:

Other MACs
First Coast Service Options, Inc. (MAC for Jurisdiction N) provides a section on
their home page which explains what First Coast does as a MAC, an explanation of
where they are located, and their mission. They also include pictures and the
companys value statement: the right things, the right way.


Recommendation: Because the current link to the About Us page is small

and on the bottom of the web page, WPS should make the page more
prevalent to allow providers to learn more about their MAC. In addition,
making this page more colorful and having pictures would make WPS GHA
seem more accessible and friendly to providers and beneficiaries. WPS GHA
should include their tagline A Nations Promise, Kept. on the About Us
page to let providers know what WPS GHA is committed to. A link to WPS
Health Solutions as a company could also be helpful for people coming the
website to know more about WPS as an entire corporation.

Trainings and Education for Providers

MACs serve as the primary contact and resource for all Medicare providers in their
jurisdictions. One of the main roles for MACs is to make sure providers are educated
on the claims filing process and Medicare. All MACs are required to provide trainings
to their providers. It is important that these are easily accessible on their websites


and providers do not have to sift through an entire website to find the trainings they
need to successfully submit their Medicare claims.
WPS Current State
WPS GHA offers live training, on demand training, minutes to their Provider
Outreach and Education Advisory Groups, and more on their Medicare website. They
also have an FYI Database, which allows providers to search for topics. The WPS
GHA resources section provides an acronym lookup, tips for first time visitors, and
information for new providers. Based on feedback from providers and the MSI,
providers in WPS GHAs jurisdictions seem generally happy with the trainings and
resources WPS GHA provides. On the website, however, the trainings are in many
different places, possibly creating a disorganized feel to the training and resources

database. Also, trainings could get confused with CSNAP, another online portal
where providers submit claims and view status updates.
Other MACs
Cahaba (MAC for Jurisdiction J) offers their providers Cahaba University,
which is a centralized training program. It gives providers easy access to
information on Medicare claims and trends. It provides more of a one-stop shop
for providers who may be in a hurry or busy. Other MACs also utilize the University
way of providing trainings/resources.


Recommendation: though providers have given positive feedback on WPS GHAs

offerings for trainings and resources, the new website could make these trainings
more one-stop and accessible with a single click. This way, providers wont feel
overwhelmed by the information or the ways to access it. Keeping our trainings how
they are, but reorganizing how they are presented on the website, could help make
us a more accessible MAC. CSNAP and the WPS GHA website should be merged in
order for providers to only have to go to one site when they need to access
information, submit their claims, or check their claims status.
Social Media
Many MACs have social media pages or blogs specific to their role as a MAC. These
pages can provide updates concerning Medicare, trainings, updates, useful tips, and
more. Social media is becoming increasingly prevalent, and is being used now more
than ever. Providers like to see social media pages or blogs where they can get
quick updates on things happening with Medicare and their specific MAC, in case
they do not have time to read a long report or email. Social media accounts can also
make MACs more approachable and friendly. Social media and blogs show providers
that MACs are committed to keeping providers updated and are up to date
themselves with Medicare. Though WPS has social media pages for Health
Insurance/Solutions as well as WPS Military and Veterans Health (MVH), it would be
helpful to providers if WPS GHA had their own social media accounts they could post
Medicare-specific information on.
Other MACs:
CGS Administrators, LLC (MAC for Jurisdiction 15) provides links on their website to
each of their social media accounts, which they separated into Part A, Part B, HomeHealth-Hospice, and Durable Medicare Equipment (WPS does not administer for the
latter two.) This way, providers can click on the links that they are specifically
interested in learning more about.


Example post:

Recommendation: by creating Facebook and Twitter accounts, as well as a blog,

WPS can get the word out to providers about trainings, update providers on changes
to claims submissions, and make their providers more informed. When providers are
more informed, they are better able to submit claims, reducing the number of
appeals, cutting costs for WPS GHA, and making WPS GHA more efficient. The
implementation of social media accounts for WPS GHA will help in many areas of
claims processing.
Facebook: Facebook can be used by WPS GHA as a powerful resource that can
increase our credibility and provide valuable information about our core audiences.
We are missing this opportunity to engage with our target markets and our
competition is bypassing us by already utilizing this resource. Facebook will allow
WPS GHA to share links easily that contain a lot of information. A lot of the
population is on Facebook, and will be willing to click on links that are shared by the
WPS GHA website because it is a fast process.
Twitter: Twitter can be used to share short updates, remind providers of upcoming
trainings, and more. It is a resource that gives very short updates that can be read
in seconds, which is attractive to providers who do not have the time to read an indepth report but still need to know about updates/reminders. Twitter is a growing
social media and beginning to use it now will set WPS apart for the future.


LinkedIn: LinkedIn can provide an outlet for rich content that showcases us as a
thought leader with our audiences. LinkedIn is unique because it is more of a
professional social media that more of our target audience could be using for work,
not personal purposes.
Internal Communication
A huge part of being a successful MAC is making sure that internal communication
in the WPS GHA department is up to speed and that all employees are able to
answer provider inquiries, efficiently process claims, and provide exceptional
customer service.
In general, WPS GHA receives positive feedback from providers, and performs
outstandingly on the MSI. Improving internal communication to become an even
better MAC will set WPS GHA apart and enable WPS GHA to grow as a MAC.
Currently, WPS GHA has a Medicare Employee Committee. This group consists of
about 20 people including the Human Resources business partners and front line
staff with representatives from each office. Jay Martinson and/or Janet Kyle meet
with the group to discuss what is happening with Medicare. The purpose of the
commitee is to resolve employee concerns and it gives the management staff an
opportunity to discuss Medicares business strategy. This group is well connected
with their peers. This group is especially useful because it allows staff to know more
about Medicare and increases the communication between employees in the
Medicare division, so everyone is up to speed. Possible opportunities for growth with
WPS GHAs internal communication would be:
Expanding the Employee Committee
Rotating members on the committee
Having the representatives on the committee meet with their offices after the
meeting to discuss what happened at the meeting
Creating an online forum where employees could submit Medicare questions that
could be answered online or in person
Currently, executives, directors and managers are expected to communicate
the message down and there are too many layers so the message gets
diluted or misinterpreted. Making communication direct and sent straight to
those it applies to will aid in streamlining internal communication.
Improve Efficiency
Efficiency and reduction of error will occur with the implementation of OnBase
Initially, OnBase will only be implemented for Jurisdiction 8 but will later also be
implemented for Jurisdiction 5
Improving the time it takes to process claims and appeals and get back to providers
on their inquiries will improve efficiency as well as cut costs
Improve Innovation
Using OnBase is a new, innovative way to process claims
Additions of new technologies that help WPS GHA process claims faster than ever
will help us stand out as a leading MAC


Fully integrate WPS GHA into WPSICs rebranding

Use name change and tagline to better define the WPS GHA brand
Use WPS GHA brand attributes to build the brand:
Efficient: contains client costs through efficient operations
Claims administration systems and processes become a precise art form; staff
training and technology ensure accuracy and speed to the point of competitive
Operates lean and mean to contain client costs
Customer focused: operates according to unique client needs
Dedicated and specially-trained customer service staff
Operates within a series of client informed, self-imposed service standards that are
measurable and reportable
Innovation leader: sets the industry pace for technology and processes
Aggressively pursues, invents or invests in new technologies and innovations that
allow it to better serve its clientele at all levels (clients/government agencies,
Medicare recipients, TRICARE recipients, providers); these may include claims
administration technology, communications platform, service triage/response
technologies, electronic platforms, etc.
OnBase implementation
Value-added drive: delivers extra value beyond client requirements
Beyond the requirements of contract RFPs, the brand shows tangible and intangible
value that sets a higher standard for competitors to meet. Being in tune with clients
unofficial hot buttons allows the brand to excel in, and promote, valuable service
components that clients arent even asking for
Experienced: accumulates knowledge to inform best practices
Staff includes a representation of people who genuinely understand the nuanced
needs of the end-customers
In touch: stays connected with customers and their values
Leadership includes highly-experienced benefits professionals and communications
staff who embody vision and leadership
Actively participates in the organizations that military and retired customers are
involved in
Understands client/government infrastructure and processes
Uses social media to reduce customer service cost
Maintains strong, productive relationships with influencers and agencies in key

Marketing/Communications Objectives
Marketing will play a significant role in achieving the business goals and will aid in
WPS GHAs success by delivering on the following initiatives.
Healthy Customer Relations: Be a top performing contractor, thought
leader and partner to CMS


Use all available resources to make sure we are offering the most up-to-date, useful
information to providers in order to make our providers the most knowledgeable
they can be on the claims submitting process
Constantly communicate with CMS in regards to our innovative technologies, best
practices, and performance metrics
Collaborate whenever possible, engage providers with CMS as well
Maximize technology proficiency
Implementation of OnBase, which will make claims processing faster and more
Increase internal communications to educate and train all employees on new
technologies and practices
Communicate with IT to understand what types of technologies WPS GHA could
benefit from
Fully engaged workforce
Improve internal communications including expanding employee meetings,
soliciting for advice on best practices, creating a database for employees to share
questions they get from providers, etc.
Encourage employees to come up with new ideas to cut costs, make claims
processing more efficient, etc.
Engage employees in the process of using more innovative technologies
Continue to develop partnership with CMS in order to establish WPS GHA as a
leading MAC and acquire new units such as Home Health and Hospice
Encourage employees to think outside the box when it comes to relationship with
CMS and how we can grow within CMS
Profitable Growth
Establish WPS GHA as a leading MAC in cost cutting, innovation, and customer
service in order to maintain contracts and gain new contracts
Provide the best possible trainings and resources to providers in order to cut costs,
as submitting appeals is a costly and timely process that makes us less efficient, but
when providers know what they are doing and are able to either submit claims
correctly the first time or realize their mistakes, costs are cut down
Possibility to incentivize providers to use or attend trainings in order to have a more
informed provider base
Determine which jurisdictions to attempt to add to our current workload up to the
maximum workload any MAC can have and attempt to gain these jurisdictions and
become a leading MAC not only in the service we provide but the amount of claims
we process
MSI Data
Obtain more data from MSI, providers and CMS to benefit WPS GHA in improving its

Market Research
The government contracts business builds on experience and performance history
to deliver high-value intangibles beyond the request for proposal. These might
include new technologies, service standards and reporting tools.
Touch Points



CMS Outreach: liaison who handles contracts and funding, white papers
Provider outreach: newsletter, direct mailings, website/portal, training sessions
Making submitting claims easy and quick, providing information
Member outreach: supplement is direct to consumer
Showing a timeline of when they can enroll or an easy-to-follow FAQ of when they
can enroll and start using Med. Supp.
Each month, WPS Manager of Provider Outreach lists comments received on
surveys from providers. Here are some of the comments we have received from
Handout book was awesome! Claim examples were wonderful and will be very
helpful in the future
Speakers [at the event] included individuals and organizations such as physicians,
health care law firms, congressional staff, hospital associations, congressional
advocacy members, recovery auditors, other MAC contractors and the U.S.
Department of Health and Human Services.
Always appreciate the educational opportunities that WPS offers- and you all do a
great job excellent presentation of the material and the speaker was so
welcoming to questions from the audience. Responses to questions were detailed
and didnt leave you wondering what you needed to do.
Our carrier is Noridian, but anytime we have a question regarding modifier usage,
wpsmedicare is first, and in most instances, the only site we go to. The information
is complete and presented in an organized, concise format that is also user
I am very pleased that WPS took the initiative to provide additional guidance on
the subject; the presenter was great.
It was very helpful to see the information- where the tabs took you- while it was
being talked about (survey response from website demonstration)
Tactical Calendar
OnBase goes live for Jurisdiction 8, (October/November 2015)
implementing a more efficient means of processing claims and databasing
information. The implementation of this program will allow WPS GHA to show
CMS the technology innovation and efficiency it is implementing.


Rebranding is ongoing and continues to roll out over the next few months.
This rebranding will occur company-wide, but will specifically help WPS GHA
get more name recognition and reduce confusion when it comes to the
different WPS brands.
September retreat- board approval
October 1 for November launch- Internal communications and brand rollout plan
October- executive staff feedback approval on rollout
October 15- comprehensive 2015 action plan


External Communication
Website redesign is being done by Base22 and will be completed in March
2016. This will help WPS GHA better service providers in their jurisdiction by
making the website more user-friendly.
Implementation of a social media strategy: with the implementation of a
social media strategy across multiple networks, WPS GHA will be able to
become a more approachable company that gives timely updates to those
Internal Communications
Redefining internal communications will be crucial in order for WPS GHA
to continue to be a leading MAC because it will allow for better customer
service and streamlining of processes, such as Part A and Part B claims.