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    Jenni Bertels   

Electronic Data Interchange (EDI)

EDI Medical Bill Reporting:
  Send us an email about EDI Medical Bill Reporting questions
  Medical EDI Traffic Report
  To obtain Expanded List of Valid Revenue Codes (NUBC webpage)
  List of insurers and self-insured employers required to report medical bill data (now Bulletin 359)
  List of taxonomy codes that do not require a diagnosis code
  Frequently asked questions for EDI medical bill reporting
  Rules affecting EDI medical bill reporting - OAR 436-160
  Medical Bill Data Element Requirement Table
  DN Error Message Table: (PDF) | (Excel)
  EDI Medical Billing Trading Partner Profile Form: Trading Partner Profile (Form 4015)
  Oregon Data Elements by Source table
  Obtain IAIABC EDI Medical Implementation Guide
  Release 2 Transition FAQs and Updates
  Transition to ICD-10 Codes (Information)
  Oregon critical access hospitals are not required to report the MS-DRG codes on their inpatient bills. [Most Oregon hospitals are required to report the appropriate MS-DRG codes on their workers' compensation inpatient hospital bills. (4/1/11)]
    The list of required Oregon hospitals can be found in Oregon Administrative Rule 436-009, Appendix A.

EDI Proof of Coverage Reporting:
  Division 162 Electronic Data Interchange; Proof of Coverage Rules - Current | Effective 4/1/2015
  Oregon EDI Implementation Guide for Proof of Coverage - December 2010
  Proof of Coverage Edit matrix/DN-Error Message Table - Current (PDF)| Effective 4/1/2015 (PDF, Excel)
  Proof of Coverage Element Requirement Table (Appendix A) - Current (PDF) | Effective 4/1/2015 (PDF, Excel)
  Proof of Coverage Data Element Issuance Conditions (Appendix B) - Effective 4/1/2015 (PDF, Excel)
  Proof of Coverage Event Table (Appendix C) - Effective 4/1/2015 (PDF, Excel)
  Insurer registration requirements
  Employee Leasing Policy Identification
  Proof of Coverage Forms
  • Trading Partner Agreement for Filing Guaranty Contracts through EDI (Form 4820) - For EDI transactions effective before 7/1/2009. Contact the EDI Coordinator in order to use this form.
  • EDI Insurer Profile (Form 4821)| PDF, Word - For EDI transactions effective after 7/1/2009 - Current
  • Proof of Coverage EDI Transmission Profile (Form 4979) | PDF, Word - For EDI transactions effective after 7/1/2009 - Effective 4/1/2015
  For proof of coverage questions or additional information, contact our EDI Coordinator at 503-947-7742 or edinews.wcd@oregon.gov.
eBilling for Workers' Compensation
  Ebilling rules, companion guide, resources, and more

Other resources:



International Association of Industrial Accident Boards and Commissions (IAIABC)


National Council on Compensation Insurance


Insurance Services Office

If you have questions about this webpage, please contact Jenni Bertels, 503-947-7742.