Oregon Health Plan EDI Partnership Program Guidelines
Oregon Health Plan EDI program will be right for you if you submit 15 or more claims a month. You can submit EDI claims directly to Oregon Health Plan using your current office management software, or contract with a service that transmits the EDI claims for you (e.g., a clearinghouse or billing service).
To exchange EDI transactions with Oregon Health Plan EDI program, you must become a registered EDI Trading Partner. You or the service that will submit transactions for you must also register as an approved EDI submitter. To register, you should complete the EDI registration packet. When you register, you will need to select the type of EDI transactions you want to exchange with Oregon Health Plan.
Once Oregon Health Plan approves your completed Trading Partner Agreement, EDI Support Services will contact your designated EDI submitters and provide them with specific instructions, logins and passwords to complete business-to-business (B2B) testing to make sure the transactions you submit can be processed by Oregon Health Plan EDI system.
Exchange EDI transactions with Oregon Health Plan
As with paper claims, before submitting EDI claims to Oregon Health Plan, you must verify that the client was eligible on the date services were provided.
- You can keep informed of current EDI system status through EDI Updates, and receive payments via direct deposit.
- Change your password on the Provider Web Portal every 45 days.
Stay and keep informed
EDI submitters (e.g., clearinghouse or software team) need to make sure their submissions to Oregon Health Plan meet national, state, and Oregon MMIS requirements. Sign up at the Oregon Health Plan web-site to receive EDI updates whenever the company updates technical specifications or issue a new EDI Bulletin (Oregon Health Plan’s periodic update to Oregon Medicaid trading partners).
You must notify Oregon Health Plan of any material changes within 10 business of the change. Oregon Health Plan will only accept change notifications that include the signature of the authorized signer on your current Trading Partner Agreement.