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Texas Department of Insurance
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Texas electronic data interchange (EDI) resources

Claims EDI news and resources | Contact us | Medical state reporting | Claims state reporting | Proof of coverage (POC) | Health plan claim matching


Claims EDI 3.1 news and resources

To access Texas Claim EDI requirements and FAQ, go to https://txdwcedi.info.


EDI Technical Group

Quarterly meetings take place 1:30 - 3 p.m.

October 25, 2021 agenda | recording 


Contact us

To contact EDI Support Services for assistance with your EDI questions, send an email to edisupport@tdi.texas.gov.

EDI Support Services can provide additional assistance on the following items:

  • Self report an EDI compliance issue;
  • report server problems;
  • become a trading partner for EDI processes;
  • request EDI reports to monitor data accuracy;
  • troubleshoot error logs and acknowledgments; and
  • ask other technical EDI questions.

Medical state reporting EDI

Rule reference:

28 TAC §§133 GENERAL MEDICAL PROVISIONS 
28 TAC §§134.800 – 134.808  MEDICAL BILL REPORTING

Reference tables and links:

Texas EDI Medical Data Element Requirement Table, Version 2.0, September 2015 (PDF)
Texas EDI Medical Data Element Edit Table, Version 2.0, September 2015 (PDF)
Texas EDI Medical Difference Table, Version 3.0, September 2015 (PDF)
Certified Workers’ Compensation Networks

FAQs:

Texas medical state reporting FAQ, July 2020

Forms:

EDI-01 - EDI Trading Partner Profile, Rev. 4/22 (PDF)
EDI-02 - Insurance Carrier or Trading Partner Medical Electronic Data Interchange (EDI) Profile, Rev. 4/22 (PDF)
EDI-03 - Medical EDI Compliance Coordinator and Trading Partner Notification, Rev. 2/22 (PDF)


Claims state reporting EDI

Rule reference:

28 TAC §§124  CARRIERS: REQUIRED NOTICES AND MODE OF PAYMENT 

Reference documents:

Texas Claims EDI Implementation Guide, Version 1.1 (Word)
Texas Claims EDI Data Dictionary (Word)
EClaims EDI Events, Elements and Edits (Excel)
Revision Control History (Excel)

Form:

EDI-01 - EDI Trading Partner Profile, Rev. 12/07 (WORD)


Proof of coverage (POC) EDI

Verify coverage: Employer workers' compensation coverage verification

Rule reference:

Texas Labor Code §406.006(b) INSURANCE COVERAGE AND CLAIM ADMINISTRATION REPORTING REQUIREMENTS; ADMINISTRATIVE VIOLATION
Texas Labor Code §406.009 COLLECTING AND MAINTAINING INFORMATION; MONITORING AND ENFORCING COMPLIANCE

References:

Commissioner’s Bulletin #B-0010-09
National Council on Compensation Insurance


Health plan claim matching EDI

Rule reference:

Texas Labor Code 409.0091 REIMBURSEMENT PROCEDURES FOR CERTAIN ENTITIES 

Reference documents:

Health Plan Claim Matching EDI Implementation Guide (PDF)

Forms:

Health Plan Claim Matching (251) Agreement (PDF) 
DWC Form-026, Request for Reimbursement of Payment Made by Health Care Insurer (PDF)


eBill - electronic medical billing

eBill information 

For more information contact edisupport@tdi.texas.gov.

Last updated: 9/8/2022