Text Size:   A+ A- A   •   Text Only
Find     
Site Image

Frequently Asked Questions About Electronic Data Interchange
  
  
Answer
EDI RegistrationHow do I submit encounter data to DMAP?

Sign up for EDI and follow our Encounter Data Submission Guidelines.​

EDI ProductionI have been blacklisted from the Oregon Medicaid SFTP server in the past due to unsuccessful logon attempts. How can I prevent this from happening?

Be sure to change passwords before they expire. Make sure that any software you use has “retries” set to zero.

EDI ProductionHow does Oregon Medicaid handle scripts that run to submit transactions and/or pick up response transactions?
Oregon Medicaid does not have a policy against running scripts, but we strongly advise against it. This may be one of the reasons some users frequently get blacklisted.
 
Scripts do not typically address password requirements, resulting in calls to reset the password. If you do not disable the script, we cannot easily reset the password.
EDI ProductionDoes my password to the mailbox ever expire?
Passwords expire every 90 days.  No notifications are sent.
 
This time starts from the time you are assigned a password and you change it for the first time.
EDI ProductionWhat are the maximum transactions per file?

Claims files should be limited to 30,000 claims. It is recommended that large transmissions be sent before Noon Thursday to ensure processing before our Friday financial cycle begins.

EDI ProductionFor the 999, what is the turnaround time for your reports?

Around 10 minutes.​

EDI ProductionI did not receive a response 999 or TA1. Should I re-submit my transactions?

No. Please contact EDI Support (DHS.EDISupport@state.or.us) if you have not received a 999, TA1, or NCPDP Response file within an hour.  Resending the file, before the issue is researched, may result in “dupe” claims.

EDI ProductionSince we are required to enter a physical address in our claim submissions, how are you able to send payments to our mailing address?

We do not use addresses that come in with the claim; instead, we send payment to the address already in our system that the provider gave when they enrolled with DMAP.

EDI RegistrationCan I list all providers on the first page of the TPA, or do I need to list each separately? 
All DMAP EDI Registration Numbers should have separate TPAs with associated National Provider Number (NPI), taxonomy code(s) and DMAP EDI Registration number.
 
The TPA is for the billing provider only. For example, if a clinic bills on behalf of its rendering providers, then only one TPA is required (for the clinic).
EDI RegistrationDoes Oregon Medicaid accept COB claims?

Yes.  We accept, and process, properly formatted claims that have had prior payers.

EDI RegistrationWhich File Level Acknowledgement (typically 997 or 999 only) does Oregon Medicaid support?

X12 requires the “Implementation Acknowledgement for Health Care Insurance” (999) when an Acknowledgement is returned for 5010 version HIPAA transactions.

EDI RegistrationIf I register for the 835 Remittance Advice (RA), can I still receive the paper RA?
Yes. There is a transition period where you will receive both the electronic Remittance Advice and the paper RA.  This period allows you to verify that you can process the 835s you receive.
 
Oregon Medicaid will continue to produce the paper RAs after a provider begins receiving the 835 remittance advice. You can ask us to stop sending you the paper RA at any time.
EDI RegistrationDoes Oregon Medicaid have EDI software available?

No.  Oregon Medicaid does not provide, or recommend, EDI software.  Your current billing/practice management software may already be set up for EDI.

We recommend contacting your business software team, your local professional association, or review the resources on our main EDI page.

EDI RegistrationWhat is a Trading Partner Agreement (TPA)?
The TPA is a group of documents that define “terms of agreement” between the entity sending/receiving the transactions and Oregon Medicaid.
 
It requires the signature of the person that is authorized to enter into the contract.
 
You will also indicate the transactions authorized and who will send/receive them.
 
The Trading Partner Agreement (TPA) is a binding agreement between Oregon Medicaid and a provider (OAR 943-120-0100). Oregon Medicaid requires all of those planning to do electronic business with Oregon Medicaid to sign a Trading Partner Agreement before testing.
EDI RegistrationCan we have multiple contact persons on the TPA?
Yes. Multiple contacts are allowed.  Exhibit B of the TPA allows for seven different contacts: Two provider contacts for contact or authorized signer, another two provider contacts for claims inquiries, and three contacts for the EDI submitter.
 
If you want to have additional contacts you may add them.  Additional contact information should be on “Company Letterhead” and attached to the TPA or may be written on the back of the form.
EDI RegistrationAre pharmacies required to submit a TPA?
All electronic transactions require a TPA between DMAP and the trading partner.  For example, a TPA must be completed to get an 835 Remittance Advice.
 
Pharmacies must complete a TPA for the following:
  • To submit medical professional claims (e.g., durable medical equipment or medication management services). They must also register for the 837 Professional transaction.
  • To receive the 835 (Electronic Remittance Advice). They must also register for the 835 transaction.
Pharmacies who only submit claims via point of sale and who do not want the electronic RA do not need to submit a TPA or register for transactions.
EDI RegistrationCan I fax or email my TPA once it is completed?

No. We require a hardcopy with an original signature before completing the TPA process.  As with any legal document, do not use correction fluid.

EDI RegistrationAs a provider, do I need to submit a TPA for my EDI submitter(s) as well as for myself?
The TPA that you submit, as a provider, asked for information about the submitter.   You need to indicate who will be submitting/receiving the transactions.
 
There is additional information that must be provided if you are going to have someone else send/receive the transaction(s).
 
You only need to submit one TPA. It identifies the provider’s agreement to exchange information with Oregon Medicaid. Exhibits A and B explain how that information will be exchanged.
 
If you exchange information on your own behalf but also use an EDI submitter for some of your work, then you will need to include two completed copies of Exhibits A and B. One copy will indicate the transactions you will submit; the other copy will indicate which transactions your EDI submitter will send on your behalf. The second scenario requires the submitter to complete Exhibits A and B to include their information and signature.
EDI RegistrationAs a clearinghouse, how do I register with Oregon Medicaid when a provider joins our service?
An Oregon Medicaid provider would have to designate you as their submitter.          
 
If the provider has a TPA on file with Oregon Medicaid, then the provider can submit Exhibit C (EDI Registration Change Form) to identify you as their new EDI submitter.
 
If the provider is new to Oregon Medicaid, then the provider must complete the full EDI Registration Packet (TPA and Exhibits A/B).
EDI RegistrationWho should sign the TPA?

The TPA should be signed by a person in your company that is authorized to enter into contracts.

The authorized signer is the person of authority in the provider's office. This does not include a billing service. The authorized signer can delegate another person to have signing authority such as an office manager to make changes to the TPA. If you choose to have a deleted signer in addition to the authorized signer, make sure to clearly identify the delegate on the TPA. ​

EDI RegistrationMy company name changed, but not my tax identification number. Must I complete a new TPA?

Yes.  Also please be sure to contact our Provider Enrollment staff (800-422-5047) to update your records.​

EDI RegistrationI realized I checked a transaction that I am not going to be submitting. Do I need to make any changes to the TPA?

Yes.  Please complete the EDI Registration Change Form (Exhibit C).  Choose “Delete” for those transactions you will not be doing.

EDI TestingWhen reporting a problem to EDI Support Services, is it necessary to tell you if it's a test or production file?

Yes. Please identify if it in test or production.  You should also include the mailbox (MB######) number, transaction type (837P, 873I, 270, etc.) date submitted, file name, NPI, and your DMAP “EDI Registration Number”.​

EDI TestingWhat type of claims should I use during testing? Can I use sample/dummy data? How many claims should I put in a test data file?

You should submit claims that mirror what you will be submitting in production.  For example, if you only plan to submit claims for “office visits” you should submit 837 Professional claims.  Batch test files should contain between 25 to 50 records. 

Oregon Medicaid expects you to use real, live claims for testing purposes. Test data must not have dates more than 365 days from the original date of service. ​

EDI TestingWhat is Oregon Medicaid's expectation for passing business-to-business testing?

You should be able to submit records and have them successfully process in our MMIS system.

Oregon Medicaid strongly encourages providers to test the coordination of benefit segments. Oregon Medicaid will run the file through Edifecs and Claredi edits before setting the file up to process in our test environment.

If the file passes the structural and data requirements of Edifecs and Claredi, Oregon Medicaid will process the file in our test environment and generate an error report.

If the file has not exceeded the threshold of any more than 10% error rate, Oregon Medicaid will notify you of a provisional pass status for production. If the file exceeds the 10% error rate, review the error report for possible modifications. ​

EDI RegistrationWhat is your Payor ID?

Oregon Medicaid's Payor ID is ORDHS.​

​​​​​