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.
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:
- Go to https://editesting.tmhp.com.
- Click Register for a TMHP community account.
- Submit the required information. TMHP will create an account for you within 24 hours.
- Begin testing. EDIFECS automatically tracks testing results, reports capabilities, and helps resolve errors.
- 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.
The following resources are available to assist providers and third parties who wish to submit electronic transactions to TMHP:
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):
Acute Care Reference Codes
Long-Term Care Reference Codes
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.
- Workgroup for Electronic Data Interchange (WEDI)- This site provides implementation materials and information.
- EDIFECS – TMHP website for EDI Testing