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    Brian Fordham   
503-947-7528   

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
 
  Rules affecting EDI medical bill reporting - OAR 436-160: Current | Effective Oct. 1, 2014
       
  Medical Bill Data Element Requirement Table: Current | Effective Oct. 1, 2014
     
  DN Error Message Table: (PDF) | (Excel)
 
  EDI Medical Billing Trading Partner Profile Form: Trading Partner Profile (Form 4015)
 
  Oregon Data Elements by Source table
 
  Obtain IAIABC EDI Medical Implementation Guide
 
     
  Release 2 Transition FAQs and Updates
  Release 1.1 to Release 2.0 transition documents (revision in progress)
  Transition to ICD-10 Codes (Information)
  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)]
    The list of required Oregon hospitals can be found in Oregon Administrative Rule 436-009, Appendix A.
 

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:
 

HIPAA

 

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 Brian Fordham, 503-947-7528.