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    Edward C. Lanssens   

Electronic Data Interchange (EDI)

EDI Medical Bill Reporting:
  Send us an email about EDI Medical Bill Reporting questions
  Medical EDI Traffic Report
  Oregon EDI Medical Bill Reporting Implementation Guide 12/14/10
(Includes ANSI loop, segment, data element summary, and file naming instructions.)
      To obtain Expanded List of Valid Revenue Codes (NUBC web page)
      List of insurers required to submit medical billing data (now Bulletin 359)
      List of taxonomy codes that do not require a diagnosis code
  Frequently asked questions for EDI medical bill reporting
      Medical Bill Data Element Requirement Table (OAR 436-160-410 see page 10)
  EDI Medical Billing Trading Partner Profile Form: Trading Partner Profile (Form 4015)
  Oregon Data Elements by Source table
  Obtain IAIABC EDI Medical Implementation Guide
  Current Rules affecting EDI medical bill reporting:
      Division 160 - Electronic Data Interchange Rules
  Release 1.1 to Release 2.0 transition information
      Oregon Medical Bill Data Electronic Data Interchange (EDI) Guide (Effective 7/1/2014)
      Division 160 Electronic Data Interchange Rules (Effective 7/01/14)
      Medical Bill Data Element Requirement Table - Appendix A (Effective 7/01/14)
      Oregon Medical EDI Data Element Requirement Conditions - Appendix B (Effective 7/01/14)
      Edit Matrix (By Segment) New (3/19/2014)
      Edit Matrix (Numerical) New (3/19/2014)
      Medical Release 2 Population Restrictions Table New (3/19/2014)
      Medical 2.0 Valid Value Table New (3/19/2014)
      Medical Release 2.0 Detail Transaction Sequencing New (3/19/2014)
      Medical Release 2.0 Summary Sequencing Table New (3/19/2014)
      Medical Reporting Event Table New (3/19/2014)
  Transition to ICD-10 Codes (Information)
    The list of required Oregon hospitals can be found in Oregon Administrative Rule 436-009, Appendix A.
  Oregon critical access hospitals are not required to report the MS-DRG codes on their inpatient bills. [Most Oregon hospitals are required to report the appropriate MS-DRG codes on their workers' compensation inpatient hospital bills. (4/1/11)]

EDI Proof of Coverage Reporting:
  Division 162 Electronic Data Interchange; Proof of Coverage Rules
  Proof of Coverage Data Element Requirement Table (see 436-162-0310, Appendix A, page 11)
  Oregon EDI Implementation Guide for Proof of Coverage - December, 2010
  Proof of Coverage-Edit matrix
  Trading Partner Agreement, (Filing Guaranty Contracts), Form 4820; for information contact:
      EDI Coordinator: 503-947-7742; E-mail: edinews.wcd@state.or.us
      Oregon Proof of Coverage EDI Insurer Profile Form 4821
  Insurer registration requirements
  Employee Leasing Policy Identification

eBilling for Workers' Compensation
  Proposed ebilling rules, companion guide, resources, and more

Other resources:



International Association of Industrial Accident Boards and Commissions (IAIABC)


National Council on Compensation Insurance


Insurance Services Office

If you have questions about this webpage, please contact Edward C. Lanssens, 503-947-7742.