An introduction to electronic business practices

• Step 1: How will you submit EDI claims?
• Step 2: Register with DHS
• Step 3: Exchange EDI transactions with DHS
• Step 4: Keep informed

If you are new to the EDI concept, read the About Us page for a short history of HIPAA. Then “get on board” by following the steps listed below. If you have questions, contact DHS EDI Support Services at DHS.EDIsupport@state.or.us or call 888-690-9888.

Step 1: How will you submit your EDI claims? 

Once you decide to bill DHS using EDI, you will need to select how you will submit your EDI claims. You can submit them using HIPAA-compliant software with your own Internet connection; contracting with a clearinghouse that will translate your data to a HIPAA-compliant format; or using a billing service that transmits the EDI claims for you.

• EDI 101 (PDF) – This “manual for beginners” provides more information on the pros and cons of EDI, how to choose the EDI billing method that’s right for you, and more.
• Questions to ask EDI vendors (PDF)
• Questions to ask vendors, clearinghouses, and payers  – From the Oregon and SW Washington HIPAA Forum
  Oregon DHS Registered Clearinghouse List  (PDF) (Updated 8/27/08) - A list of EDI clearinghouses that are registered as current trading partners with DHS. This list does not imply any endorsement by DHS of services or products listed.

Step 2: Register and test with DHS

All business entities who want to do electronic business with DHS must become a registered Trading Partner. The entity that will submit your EDI transactions to DHS (you, a billing service or clearinghouse) must also register as an approved EDI submitter.  

You will need to select the type of EDI transactions you want to exchange with DHS. In addition to claims and remittance advice transactions, there are EDI transactions for claims status and eligibility inquiries.  

After DHS approves your registration, you will need to go through business-to-business testing to make sure the transactions you submit can be processed by our system. For more information, go to the EDI Registration and Testing page.  

REMINDER: DHS will end new registration and testing in the current system on June 30, 2008. Any new registrations received on and after July 1, 2008, would not be processed until December 2008, when the replacement MMIS is fully operational.

Step 3: Exchange EDI transactions with DHS

As with paper claims, before submitting EDI claims with DHS, you must verify that the client was eligible on the date services were provided. You can keep informed of current EDI system status, and receive payments via electronic funds transfer (EFT, or direct deposit). For more information, go to the EDI Production page.
 

Step 4: Keep informed

All communications from DHS about EDI can be found on the EDI Communications page. Make sure to eSubscribe to get notification whenever we post a new EDI communication.

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