Electronic Data Interchange (EDI)

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

New to EDI?

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. Once you know who will submit EDI transactions for you, complete OHA's Trading Partner Agreement (TPA) for Electronic Health Care Transactions. 
   
2. Sign the form. Both the provider and EDI submitter must read and sign this form. 
   
3. Scan the signed, completed form and email it to OHA.TPAgreements@oha.oregon.gov. Please keep the original signed copy for your records.
   

Please allow 30 to 45 days for processing. Once your TPA is approved, OHA will email the technical contact listed in Section 7 of your TPA to begin testing.

If any required fields are incomplete or contain errors, OHA will not process or return your TPA. To send in an error-free TPA:

• Enter your Oregon Medicaid ("MCD") number and National Provider Identifier (NPI). They must match what is on file with OHA Provider Enrollment.
  
• Only list one EDI submitter per TPA. If you have more than one submitter or clearinghouse, complete a TPA for each one.
• Enter the direct/individual email address for each person on the TPA. Do not enter group email addresses, or someone else's email address.
  
• Organizations must have someone other than the primary Authorized Signer (Section 2) or primary Claims Contact (Section 3) sign Section 8 of the TPA. This can be the secondary signer in Section 2 or the secondary contact in Section 3.
  
• Do not list a billing service or clearinghouse contact as an Authorized Signer. Signers must represent the enrolled provider. Biling services may only be listed as a Claims Contact.
  

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 (this guide is not the TPA form; please only complete and submit the TPA form to OHA).
  
• 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.