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)
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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.
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.
You can learn more about EDI on the following websites:
Washington Publishing Company- The Washington Publishing Company site includes reference documents pertaining to HIPAA, such as: implementation guides, data conditions, and the data dictionary for X12N standards.
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LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT® ")
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This product includes CPT which is commercial technical data and/or computer databases and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer databases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.
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