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Sign up for EDI and follow our Encounter Data Submission Guidelines. To find all resources related to encounter data, visit our Encounter Data page.
Yes. We accept, and process, properly formatted claims that have had prior payers.
X12 requires the “Implementation Acknowledgement for Health Care Insurance” (999) when an Acknowledgement is returned for 5010 version HIPAA transactions.
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.
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.
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”.
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.
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.
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.
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.
Around 10 minutes.
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.
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).
Oregon Medicaid's Payor ID is ORDHS.
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