Oregon Health Plan EDI Testing FAQs and Guides
Oregon Health Plan EDI Testing is required for easy and comfortable connection to Oregon Health Plan EDI program. Oregon Health Plan EDI Testing passed successfully allows quick claims submitting, receiving immediate feedback on claims, eliminating mail and handling time for the claims. Oregon Health Plan EDI Testing FAQs given below make the registration and testing process clearer and easier.
When reporting a problem to EDI Support Services, is it necessary to tell Oregon Health Plans 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 Oregon Health Plans “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 Oregon Health Plans 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.