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Frequently asked questions Electronic Data Interchange - Trading Partner Agreement
Q. What is a Trading Partner Agreement? A. The Trading Partner Agreement (TPA) is a binding agreement between OR-DHS and a Provider (OAR 410-001-0110.) OR-DHS requires all of those planning to do electronic business with OR-DHS to sign a Trading Partner Agreement before testing. Q. Can we have multiple contact persons on the TPA? A. The TPA allows for two individuals each as contacts for submission, claims and contact or authorized signer. Back to top Q. Are pharmacies required to submit a TPA? A. The answer is yes and no.
A. The TPA is designed to identify the two relationships DHS must understand: 1) who the provider or trading partner is, and 2) who will be submitting the compliant transaction to DHS for payment or adjudication. So in the scenario given we are only interested in the clearinghouse ultimately sending the claim to DHS. If the relationship between the submitter the identified provider changes, you must notify DHS using Exhibit C– EDI Registration change form available on our Web site. Back to top Q. Can I list all providers on the first page of the TPA or do I need to list each separately? A. If each provider receives their own check they each have to fill out a TPA. If a clinic or group of providers receives the payment then only one TPA is required. However, follow the instructions on how to accommodate multiple individuals. Q. Can I fax my TPA once it is completed? A. Because DHS requires original inked signatures, we must have the original TPA on file. As with any legal document, do not use correction fluid. Back to top Q. I am a provider; do I need to submit a TPA for my EDI submitter(s) as well as for myself? A. If you submit on your own behalf and also use a submitter for some of your work, then yes. One TPA will indicate which transactions you will be submitting; a separate TPA, Exhibits A and B, will indicate which transactions your submitter will be sending on your behalf. The second scenario requires the TPA to go to the submitter for their information and signature. Q. Who should sign the TPA? A. The authorized signer is the person of authority in the provider's office. This does not include a billing service. The authorized signer can delegate another person to have signing authority such as an office manager to make changes to the TPA. This person should be clearly identified on the TPA. Back to top Q. Are new enrollment forms going to be required? If so, when? A. If this question is referring to Provider Enrollment forms, the answer is no. If this question is referring to the TPA, then the answer is yes. The due date was October 16, 2003, with an extension to December 31, 2003. If you have not yet submitted a TPA and you submit electronically to DHS you are out of compliance. Q. Will there be any enrollment data changes (e.g., provider IDs, data elements changing)? When will these changes take place? A. DHS does not anticipate any significant changes to the TPA registration process, however HIPAA is a federally mandated requirement and DHS must comply as the requirements change. Back to top Q. Will re-enrollment be required and what are the terms and deadlines? A. It is anticipated the HIPAA X12 formats will have changes sometime in 2006 or 2007. When that occurs, yes, the TPA will need to be revised. Q. Where can I find the EDI Registration Packet containing the TPA? A. You can download the information from this Web site. Click on EDI Packet. If you have additional questions call 503-947-5347, 1-888-690-9888, or email: DHS.EDIsupport@state.or.us Back to top Q. My company name changed but not my tax identification number. Must I complete a new TPA? A. No, follow the instructions that accompany Exhibit C. Q. I realized I checked a transaction that I am not going to be submitting. Do I need to make any changes to the TPA? A. Yes, DHS tracks and utilizes this information when setting up profiles for submission of transactions. Complete the TPA change form Exhibit C. Back to top Q. As I am not the technical or encounter data person, could you shed some light on the 837 transaction? I am under the impression that the 837 form is the standard claim form for everyone, submitted by the managed care plans to DMAP. A. The 837 is the standard transaction for all health care providers wishing to send claims to payers electronically. There are three types: the professional, institutional and dental. The professional most closely relates to the current CMS-1500 or NSF format, the institutional to the UB-92 for inpatient and outpatient and the dental to the ADA form or NSF format. There are additional differences with regard to fee-for-service claims versus managed care encounter claims. Q. Is DHS able to receive electronic claims submissions, and if so, what software (name and version) do you provide for it? A. DMAP is currently accepting electronic claims using Oregon's version of the National Standard Format (NSF) version 1.04 and the Universal Billing-92 (UB-92) formats. DHS does not offer this software, but it may be purchased from an outside vendor. DMAP is not accepting newly enrolled providers as electronic submitters in either of these formats. DMAP is also accepting electronic claims using the HIPAA-compliant 837 P, I and D fee-for-service and encounter claims. DMAP will only establish new submissions for the HIPAA complaint formats. #17 A. If you submit claims to DMAP electronically in the 837 transaction, you have the option at this time to receive the electronic 835 RA response or the proprietary paper RA. Back to top |
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