How do I submit encounter data to OHA? | |
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.
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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. |