Exchange HIPAA-Compliant Health Care Transactions with OHA
With EDI, you can submit claims, eligibility inquiries and claim inquiries to Oregon Health Authority (OHA) through your billing service, clearinghouse or practice management software. You can get your fee-for-service remittance advice using EDI, too.
If you do not use a billing service, clearinghouse or special software, and submit a small number of claims per week, the
MMIS Provider Portal may be right for you. This secure online system is free and available for most providers.
How to Sign Up for EDI
Will your office/location submit directly to OHA, or will a billing service or clearinghouse do this for you?
If you use a billing service and/or clearinghouse, they will need to complete Sections 7 and 8 of the Trading Partner Agreement (TPA) (English) (Spanish) you submit to OHA.
If you have more than one submitter or clearinghouse (for example, one service for bililng and another for eligibility inquiries), you will need to complete a TPA for each one.
Once you know who will submit EDI transactions for you, you and any other submiters need to complete and sign OHA's Trading Partner Agreement (TPA) for Electronic Health Care Transactions (English) (Spanish). Learn how to complete the 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 cannot have their primary Authorized Signer (Section 2) also be the primary Claims Contact (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.
Please allow 30 to 45 days for processing. Once your TPA is approved, OHA will work with the technical contact listed in Section 7 of your TPA to see if any testing is needed.
Always Keep a Current Trading Partner Agreement on File!
Both you and OHA must have a current TPA. To keep current:
Material changes include changes to:
- Authorized signers, transactions and EDI submitter
- Any related contact information
- Your Oregon Medicaid ID, business name or Tax ID
OHA 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.
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.\