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Electronic Data Interchange - Frequently Asked Questions

Registration

  
Answer
How do I submit encounter data to OHA?

Sign up for EDI and follow our Encounter Data Submission Guidelines.​ To find all resources related to encounter data, visit our Encounter Data page. ​

Can I list all providers on the first page of the TPA, or do I need to list each separately? 
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).

Each National Provider Identifier (NPI) must have its own TPA.

If you have multiple providers that bill OHA using the same NPI, they can all be listed on the same TPA if they will all use the same transactions and EDI submitter. Include each provider's Oregon Medicaid provider number.
 
Does Oregon Medicaid accept COB claims?

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

Which 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.

If 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.
Does 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.​​

What is a Trading Partner Agreement (TPA)?

The TPA defines the "terms of agreement" between the Trading Partner, the EDI submitter (entity sending/receiving the transactions) and Oregon Medicaid.

It requires the signature of the people authorized to enter into this 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 exchange EDI transactions with Oregon Medicaid to sign a Trading Partner Agreement before testing.

A TPA is not required for access to the Provider Web Portal. ​

Can we have multiple contact persons on the TPA?
Yes. Multiple contacts are allowed.  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.
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Testing

  
Answer
When 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 OHA “EDI Registration Number”.​

What 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. ​

What 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. ​

Production

  
Answer
I 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. Passwords for the Oregon Medicaid SFTP server expire every 45 days. Also make sure that any software you use has “retries” set to zero.

How 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.
Does my password to the mailbox ever expire?
Passwords expire every 45 days.  No notifications are sent.
 
This time starts from the time you are assigned a password and you change it for the first time.
What 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.

For the 999, what is the turnaround time for your reports?

Around 10 minutes.​

I 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 duplicate claims.

Since 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 Mail-to address in our system (provided when you enrolled with Oregon Medicaid).

What is your Payor ID?

Oregon Medicaid's Payor ID is ORDHS.​

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