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Electronic Data Interchange (EDI)

Providers that use third-party software and third-party vendors that submit claims for providers use the TMHP EDI gateway to submit claims to TMHP.

Electronic Data Interchange (EDI)

Last updated on 5/31/2020

EDI is a communications protocol for electronically transmitting secure business data.

This section provides highly technical information for:

  • Trading partners, such as billing organizations and clearinghouses.
  • Providers who create and maintain their own third-party software.
  • Third-party software vendors that create software for providers to submit claims.

Providers who want to use TexMedConnect to submit claims should visit the TexMedConnect page for more information.

Get Started

If you are a provider, trading-partner, or software vendor that wants to submit EDI transactions to TMHP, you must test your software on the TMHP EDI Testing site.

To complete the EDIFECS CommerceDesk testing process:

  1. Go to http://editesting.tmhp.com.
  2. Click Register for a TMHP community account.
  3. Submit the required information. TMHP will create an account for you within 24 hours.
  4. Begin testing. EDIFECS automatically tracks testing results, reports capabilities, and helps resolve errors.
  5. When you have completed testing, TMHP will activate your EDI account and you can begin submitting transactions.

The EDI Testing site also provides support information and resources.

A list of approved EDI vendors is available here.

Technical Information

The following resources are available to assist providers and third parties who wish to submit electronic transactions to TMHP:

The TMHP Connectivity Guide is intended for Trading Partner use in conjunction with the ANSI X12N 5010 Implementation Guides (available at www.wpc-edi.com).

There are two sets of EDI companion guides: one to help acute-care submitters and one to help Long Term Care submitters. TMHP currently uses EDI version 5010 protocols.

Acute Care Companion Guides

Long-Term Care Companion Guides

The following files are related to the Health Insurance Portability and Accountability Act (HIPAA):

Helpful Links

You can learn more about EDI on the following websites: