The EDI Guide
28 Texas Administrative Code §102.11, §124.2 and §134.802 requires that certain data be submitted to the Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC) by electronic data interchange (EDI). Help is available from the EDI/TXCOMP Help Desk regarding:
- becoming certified as a Trading Partner for EDI processes;
- requests for EDI reports;
- troubleshooting error logs and acknowledgments;
- TXCOMP access issues; and
- other technical questions.
EDI/TXCOMP Help Desk
The Help Desk is staffed Monday through Friday, 8:00 - 5:00 Central Time, not including holidays.
TDI-DWC has provided the following downloadable documents to help outline the instructions and tables for data elements, events, and edits.
The Claims EDI Implementation Guide covers the current EDI processes related to the submission of first and subsequent reports of injury.
- 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)
The following Medical EDI Implementation Guidance documents cover the EDI processes for the submission of medical bill and payment information.
- Medical Bill Reporting, 28 TAC §§134.800 – 134.808
- Texas EDI Medical Data Element Requirement Table, Version 1.0, June 2011 (PDF)
- Texas EDI Medical Data Element Edit Table, Version 1.0, June 2011 (PDF)
- Texas EDI Medical Difference Table, Version 2.0, February 2013 (Excel)
- Medical State Reporting of Diagnosis Codes and Pointers, Memo, February 2014 (PDF)
- Medical State Reporting of Claim Adjustment Reason Codes (CARC) 7/31/14
- Medical State Reporting FAQs
The Health Plan Claim Matching EDI Implementation Guide covers the current EDI processes related to request and response information.
- Health Plan Claim Matching EDI Implementation Guide (PDF)
- Health Plan Claim Matching (251) Agreement (Word)
For more information contact:
Last updated: 07/31/2014