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Electronic Data Interchange (EDI)

Providers - Learn How to Exchange HIPAA-compliant Health Care Transactions with OHA.

New to EDI?

First, read our Oregon Health Plan electronic business practices guide. If you do not use a billing service or clearinghouse, and submit a small number of claims per week, the MMIS Provider Portal may be right for you.

If you still want to sign up for EDI, follow these steps:

  1. If you use a clearinghouse, see if yours is registered with OHA. This list does not imply any endorsement by OHA of services or products listed.
  2. Once you know who will submit EDI transactions for you, complete OHA's Trading Partner Agreement (TPA) for Electronic Health Care Transactions. Both the provider and EDI submitter must read and sign this form. To learn more, read How to complete the TPA.
  3. Sign the form (do not use black ink).
  4. Scan the signed, completed form and email it to OHA.TPAgreements@oha.oregon.gov. Please keep the original signed copy for your records.

If any required fields are incomplete, OHA will contact the authorized signer. Once your TPA is approved, OHA will email the technical contact listed in Part 5 of your TPA to begin testing.

Notify OHA of Any Material Changes by Submitting a New TPA

Do this within 10 business days of the change. The TPA must be signed by the authorized signer on your current TPA. (If your EDI submitter has changed, your new EDI submitter must also sign.) Material changes include changes to:

  • Authorized signers, transactions and EDI submitter
  • Any related contact information
  • Your Oregon Medicaid ID, business name or Tax ID

Keep a Current Trading Partner Agreement on File

  • OHA now denies claims from EDI submitters who are not listed on your current TPA with OHA. If your claims deny for this reason, you need to submit a new TPA listing your current submitter
  • OHA does not accept incomplete TPA forms. To make sure you complete the TPA right the first time, please read our line-by-line instructions in How to complete the TPA
  • If you don't know who is listed on your current TPA, or do not have a copy of it, please submit a new TPA. OHA can only share information with the authorized contacts on your current TPA. It is your responsibility to keep a copy and send a new TPA when the contacts change.


EDI System Status

Answer

Change Healthcare is experiencing system issues. This may prevent providers from transacting EDI files. Learn more on Change Healthcare's status updates page.

If providers cannot check eligibility or submit claims due to this issue, they can:

  • Use the MMIS Provider Portal at ​https://www.or-medicaid.gov.
  • Submit paper claims.
  • For questions, contact Provider Services at 800-336-6016 (option 5) or DMAP.ProviderServices@oha.oregon.gov.


Quick Links

Trading Partner Agreement (TPA) Form

Providers - Learn how to complete the TPA

Testers and submitters - View Technical specifications, submitter tips and more

Questions?

See our Frequently Asked Questions.

Still have questions? Email EDI Support Services.