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.
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)