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Common Questions about Trading Partners
Trading Partners

EDI (electronic data interchange) is the direct, application-to-application transmission of business documents between business partners. EDI can significantly reduce the timeline required from initial claim submission to final payment by sending actionable information without the need for re-keying at any step along the way.

Read the Information Guide on the Trading Partner Website.

By using EDI, your company can send business documents directly from your internal computer applications to your trading partner's computer system, without human intervention. EDI minimizes staff involvement and reduces the delays and errors that accompany the manual processing of business documents. By simplifying and streamlining business procedures, EDI can help your organization control costs, increase efficiency and improve customer service levels.

EDI extracts information from your applications and transmits paperless, computer- readable business documents via telephone lines and other telecommunications devices. At the receiving end, the data can be fed directly into the trading partner's computer system where it can be automatically processed by the receiver's internal applications. All of this is accomplished in minutes.


Your company's computer system may already serve as a repository for the health care data needed to support the required EDI transactions. EDI extends the value of the investment you've made in business application software. Creating, sending, receiving and processing EDI business documents can be automated and integrated with your existing internal computer applications
 

The most general benefits of EDI are improved speed, economy and accuracy in handling business documents. More specifically, EDI offers:

  • Convenient exchange of business documents during business or non-business hours
  • Reduced business transaction costs
  • Reduced information float
  • Improved customer service
  • Quick, accurate and automatic reconciliation of documents
  • More efficient data flow at both intra- and inter- company levels
  • More productive trading partner relationships
     

An EDI standard establishes the guidelines for the series of uniform message formats used to create electronic, computer-readable versions of traditional paper documents. Many of the earliest standard message formats were first created and adopted by specific industries for the exchange of documents within that particular industry or by specific companies for the exchange of documents with their many suppliers. As EDI has evolved, the use of industry-specific or company-specific standards (also known as proprietary standards) has lessened in favor of public standards. HIPAA specifies the standards that covered entities must use.

A wide range of mainframe, midrange or microcomputer (PC) systems can be used. Many companies find they are able to exchange EDI documents using their existing computer hardware. To determine which platform best serves your company's EDI needs, you should consider such things as:

  • the volume of anticipated transactions
  • the kind of data expected
  • the number of EDI trading partners

There are several software companies that create EDI Management software. They may be found by searching on the internet. ODM does not recommend any specific software to be used for EDI management purposes.

There are several software companies that create EDI Management software. They may be found by searching on the internet. ODM does not recommend any specific software to be used for EDI management purposes.

There is no paperwork needed to submit claims on behalf of a new client if you are already a trading partner.
If you are not already a trading partner you will need to complete the process of becoming a trading partner before being able to submit the X12 EDI 837 Claims transaction. Please see the Trading Partner Information Guide for more information.

No, only those accepted for adjudication AND only if the provider is enrolled with you for the 835 remittance advice.

Call EDI Support 1-800-686-1516 Option 4 or send an e-mail to ohiomcd-edi-support@gainwelltechnologies.com

No. Only one method of transmission/retrieval can be applied for each account. You can contact the EDI Support Unit to switch at any time.

In the CERT / testing region: An e-mail must be sent to the Ohio Medicaid EDI Helpdesk (ohiomcd-edi-support@gainwelltechnologies.com). The email should contain the trading partner number and the provider IDs for whom you are requesting the 835 transactions while testing.
In Production: Submit a completed ODM 06306 form for each pay-to/bill-to provider for whom you will be the 835 Designee. This form can be found on the Trading Partner website.

If you are locked out of your account the person listed as the business, secondary, or technical contact will need to contact the EDI Support Unit via e-mail (ohiomcd-edi-support@gainwelltechnologies.com) or phone at 844-324-7089 for assistance

Check for an HTML report to see if your file may have failed HIPAA Compliance or contact the EDI support team for assistance.

To ensure your claims are included in the weekly payment cycle, claims must be submitted by noon on Wednesday.  Claims submitted after this time may or may not be included in the weekly pay cycle.  Any claims not included in the current weeks pay cycle will be included in the following week's cycle.  There is no need to resubmit.  See the EDI Processing Calendar on the Trading Partner website.

The 835 remittance advice is returned weekly. See EDI Processing Calendar on the Trading Partner website.

Currently the schedule for the 835 in CERT is every Tuesday and Thursday.
However, you must send a list of the provider numbers being used for testing for the
835 to be generated. Please limit your testing NPIs to 5 – 7 providers.

No, it is the responsibility of the entity wanting to become a trading partner to obtain their own software.

No, a provider may only authorize one trading partner to receive the 835 on their behalf. 
Providers may elect a new trading partner by completing the ODM06306
form at any time.

Yes, a provider can submit claims through as many trading partners as they would like, but the 835 can only be returned to one.

The trading partner should notify EDI Support as soon as possible, each time there is a change with the authorized contacts on file.  Changes for Primary, Secondary and Technical contacts should be sent as an attachment on company letterhead to avoid delays.
 

See the bullet ‘EDI Adjustment Instructions’ on the Trading Partner website.

Yes, the EDI system is available 24/7/365 with the exception of posted maintenance hours.

The Consumer Hotline number is 1-800-324-8680.

Provider Assistance can be reached at 800-686-1516.  Please follow all prompts.

Provider Enrollment can be reached at 800-686-1516.  Please follow all prompts.   

No. ODM or its vendor(s) cannot delete, alter or change a file on your behalf. All submitted files will be processed as appropriate.  When both files process one set of claims will be denied as duplicates.  If will be the trading partner or providers responsibility to reconcile these claims appropriately.

Yes.  Trading partners must test for each transaction and be authorized before using the real-time method.

Yes. All prior payers should be billed before Medicaid. Medicaid is the payer of last resort.  Please include all prior payer information in your claims.  For additional information see the OAC Rules for COB / TPL under Production on the TP website.

999, HTML (error report) and/or the TA1 are usually returned within an hour of submission.  The U277 and 824, when applicable, are returned 24 - 48 hours later.  The 835 is returned weekly.  See the EDI Processing Calendar.  

You should enable the TLS 1.2 in the SoapUI installation. In the SoapUI install bin directory, modify SoapUI-5.0.0 vmoptions to add the following line:  
Dsoapui.https.protocols=SSLv3,TLSv1.2
Restart SoapUI and try again.

Trading Partners who face issues using a .Net Application for real-time should contact the EDI support team for assistance.  1-844-324-7089 or ohiomcd-edi-support@gainwelltechnologies.com A possible solution could be to save a local copy of the WSDL and update the service endpoint to URL https://api.oxi.arcaas.com/OXiACAServices/v1.0/OXiRealTimeInterface