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Texas Electronic Data Interchange (EDI) Resources

General Info | Medical State Reporting | Claims State Reporting | Proof of Coverage (POC) | Health Plan Claim Matching | eBill - Electronic Medical Billing | Resource Link

FAQ of the week:

What is the format for reporting state license numbers?


Please see 28 TAC §133.10(h).   As a general rule, state license numbers are reported using the following format:  license type, license number, jurisdiction state code e.g. MDF1234TX


General Information

Texas EDI Quarterly Meetings

Division of Workers’ Compensation (DWC) holds quarterly meetings to discuss technical EDI related issues in the workers’ compensation system.

These meetings are to provide a forum to discuss technical EDI related issues. Our goal will be to discuss technical EDI issues and problem-solve through focused, open communication in an informal atmosphere.  These meetings will follow the Insurance Carrier Quarterly Meetings. 

To request a specific issue to be an item for discussion, please submit the details of the issue to smo@tdi.texas.gov for consideration.

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:

  • report server problems;
  • becoming a Trading Partner for EDI processes;
  • requests for EDI reports to monitor data accuracy;
  • troubleshooting 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:

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)

FAQs:

Texas Medical State Reporting FAQs, July 2014 (PDF)

Memos:

Medical State Reporting of Diagnosis Codes and Pointers, Memo, February 2014 (PDF)
Medical State Reporting of Claim Adjustment Reason Codes (CARC), Memo, July 2014 (PDF)

Forms:

EDI-01 - EDI Trading Partner Profile, Rev. 12/07 (WORD)
EDI-03 - Medical EDI Compliance Coordinator and Trading Partner Notification, Rev. 06/11 (PDF)

Need Assistance:

Send an email to EDI Support Services (edisupport@tdi.texas.gov) for additional assistance including the following items:

  • report server problems;
  • becoming a Trading Partner for EDI processes;
  • requests for EDI reports to monitor data accuracy;
  • troubleshooting error logs and acknowledgments; and
  • ask other technical EDI questions.



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)

Forms:

EDI-01 - EDI Trading Partner Profile, Rev. 12/07 (WORD)
EDI-02 - Insurance Carrier or Trading Partner Medical Electronic Data Interchange (EDI) Profile, Rev. 06/11 (PDF)

Need Assistance:

Send an email to EDI Support Services (edisupport@tdi.texas.gov) for additional assistance including the following items:

  • report server problems;
  • becoming a Trading Partner for EDI processes;
  • requests for EDI reports to monitor data accuracy;
  • troubleshooting error logs and acknowledgments; and
  • ask other technical EDI questions.

Proof of Coverage (POC) EDI

Link to 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 - https://www.ncci.com


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 (Word)

Need Assistance:

Send an email to EDI Support Services (edisupport@tdi.texas.gov) for additional assistance including the following items:

  • report server problems;
  • becoming a Trading Partner for EDI processes;
  • requests for EDI reports to monitor data accuracy;
  • troubleshooting error logs and acknowledgments; and
  • ask other technical EDI questions.

eBill - Electronic Medical Billing

Link to eBill information: http://www.tdi.texas.gov/wc/hcprovider/billing.html#ebill


Resource Links

ASC X12 - http://www.x12.org
International Association of Industrial Accident Boards and Commissions (IAIABC) - http://www.iaiabc.org
National Council on Compensation Insurance - https://www.ncci.com
Washington Publishing Company - http://www.wpc-edi.com




For more information contact:

Last updated: 12/08/2014

Contact Information and Other Helpful Links

Translation by WorldLingo


Translation by WorldLingo


Translation by WorldLingo