Electronic data interchange in four easy steps

• Step 1: How will you submit EDI claims?
• Step 2: Register with DMAP
• Step 3: Exchange EDI transactions with DMAP
• Step 4: Keep informed

If you submit 15 or more claims a month, EDI claim submission may be right for you. Follow the steps on this page to get started using EDI. Questions? Contact EDI Support Services (888-690-9888).

Note: Most enrolled Oregon Medicaid providers with a registered NPI can use the Provider Web Portal at https://www.or-medicaid.gov once they receive their PIN (no registration or testing required). Learn more at this link.

Step 1: How will you submit your EDI claims?

Once you decide to bill DMAP using EDI, you will need to select how you will submit your EDI claims. You can submit them using HIPAA-compliant software with your own Internet connection; contracting with a clearinghouse that will translate your data to a HIPAA-compliant format; or using a billing service that transmits the EDI claims for you.

• EDI 101 (PDF) - This "manual for beginners" provides more information on the pros and cons of EDI, how to choose the EDI billing method that's right for you, and more.
• Questions to ask vendors, clearinghouses, and payers - From the Oregon and SW Washington HIPAA Forum
• DMAP Registered Clearinghouse List (PDF) (Updated 8/31/11) - A list of EDI clearinghouses that are registered as current trading partners with DMAP. This list does not imply any endorsement by DMAP of services or products listed. 

Step 2: Register and test with DMAP

All business entities who want to do electronic business with DMAP must become a registered Trading Partner. The entity that will submit your EDI transactions to DMAP (you, a billing service or clearinghouse) must also register as an approved EDI submitter. 

• To register, complete the EDI Registration Packet. Learn how to complete the packet by viewing this tutorial (Powerpoint or PDF).
• When you register, you will need to select the type of EDI transactions you want to exchange with DMAP. In addition to claims and remittance advice transactions, there are EDI transactions for claims status and eligibility inquiries. 

After DMAP approves your TPA or submitter registration, you may need to go through business-to-business testing to make sure the transactions you submit can be processed by our system. For more information, go to the EDI Registration and Testing page.

Step 3: Exchange EDI transactions with DMAP

As with paper claims, before submitting EDI claims with DMAP, you must verify that the client was eligible on the date services were provided.

• You can keep informed of current EDI system status through EDI Updates, and receive payments via electronic funds transfer (EFT, or direct deposit).
• For more information, go to the EDI Production page. 

Step 4: Keep informed

Sign up to receive EDI updates whenever we update information or issue a new EDI Bulletin (DMAP's periodic update to Oregon Medicaid trading partners).

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