Or. Admin. Code § 407-120-0120 - Registration Process - EDI Transactions
(1) The EDI transaction process is preferred
by providers, PHPs, and allied agencies for conducting batch or real time
transactions, rather than the individual data entry process used for DDE. EDI
registration is an administrative process governed by these rules. The EDI
registration process begins with the submission of a TPA by a provider, PHP,
clinic, or allied agency, including all requirements and documentation required
by these rules.
(2) Trading
partners must be Department providers, PHPs, clinics, or allied agencies with a
current Department contract. The Department will not accept a TPA from
individuals or entities who do not have a current contract with the Department.
(a) The Department may receive and hold the
TPA for individuals or entities that have submitted a provider enrollment
agreement or other pending contract, subject to the satisfactory execution of
the pending document.
(b)
Termination, revocation, suspension, or expiration of the contract will result
in the concurrent termination, revocation, suspension, or expiration of the TPA
without any additional notice; except that the TPA will remain in effect to the
extent necessary for a trading partner or the Department to complete
obligations involving EDI under the contract for dates of service when the
contract was in effect. Contracts that are periodically renewed or extended do
not require renewal or extension of the TPA unless there is a lapse of time
between contracts.
(c) Failure to
identify a current Department contract during the registration process will
result in a rejection of the TPA. The Department will verify that the contract
numbers identified by a provider, PHP, clinic, or allied agency are current
contracts.
(d) If contract number
or contract status changes, the trading partner must provide the Department
with updated information within five business days of the change in contract
status. If the Department determines that a valid contract no longer exists,
the Department shall discontinue EDI transactions applicable for any time
period in which the contract no longer exists; except that the TPA will remain
in effect to the extent necessary for the trading partner or the Department to
complete obligations involving EDI under the contract for dates of service when
the contract was in effect.
(3) Trading Partner Agreement. To register as
a trading partner with the Department, a provider, PHP, clinic, or allied
agency must submit a signed TPA to the Department.
(4) Application for Authorization. In
addition to the requirements of section (3) of this rule, a trading partner
must submit an application for authorization to the Department. The application
provides specific identification and legal authorization from the trading
partner for an EDI submitter to conduct EDI transactions on behalf of a trading
partner.
(5) Trading Partner
Agents. A trading partner may use agents to facilitate the electronic
transmission of data. If a trading partner will be using an agent as an EDI
submitter, the application for authorization required under section (4) of this
rule must identify and authorize an EDI submitter and must include the EDI
certification signed by an EDI submitter before the Department may accept
electronic submission from or send electronic transmission to an EDI
submitter.
(6) EDI Registration. In
addition to the requirements of section (3) of this rule, a trading partner
must also submit its EDI registration form. This form requires the trading
partner or its authorized EDI submitter to register an EDI submitter and the
name and type of EDI transaction they are prepared to conduct. Signature of the
trading partner or authorized EDI submitter is required on the EDI registration
form. The registration form will also permit the trading partner to identify
the individuals or EDI submitters who are authorized to submit or receive EDI
registered transactions.
(7) Review
and Acceptance Process. The Department will review the documentation provided
to determine compliance with sections (1) through (6) of this rule. The
information provided may be subject to verification by the Department. When the
Department determines that the information complies with these rules, the
Department will notify the trading partner and EDI submitter by email about any
testing or other requirements applicable to place the registered transaction
into a production environment.
Notes
Stat. Auth.: ORS 409.050, 414.065
Stats. Implemented: ORS 414.065
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