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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.

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Implementation Checklist

Below are the steps to sign up for Electronic Data Interchange with Texas Medicaid. If you are not utilizing TexMedConnect or one of our Approved Vendors, please follow the steps below to establish an active EDI account with Texas Medicaid.

  1. Call the EDI Help Desk at 800-925-9126 Option 4 to request an EDIFECS testing site login. The following information must be provided:
    • TPI/NPI/API
    • Facility/Provider Name
    • Organization Name
    • Address
    • Contact Name
    • Contact Phone number
    • Email Address

Once the EDI Help Desk creates your EDIFECS testing site account you will receive an invitation letter via email.

  1. Once you receive your login information, you can begin submitting test transactions to the EDIFECS site. The EDIFECS site will ensure that your files are X12 syntactically correct and are HIPAA compliant. Please remember to test all transaction types you would like to send and receive once in Production. 
  1. After EDIFECS testing is successful, download and complete the following forms:

Mail all documents to: 

Texas Medicaid & Healthcare Partnership
Attention: EDI PO Box 204270
Mail stop — EDI-B14
Austin, TX 78720-4270

(Allow up to 30 days from date of receipt to process)

  1. After the EDI Help Desk receives all of the appropriate forms and agreements from step 3 and completes confirmation of EDIFECS testing completion, a Submitter ID will be assigned for end-to-end system testing. Please Note: Your submitter ID will only be valid in test environment until approved for production.
  2. Download the TMHP EDI Connectivity Guide for connectivity information to establish a connection with Texas Medicaid to send and receive files for both the Test and Production environments.
  3. Complete end-to-end testing in the TMHP test environment. All trading partners are required to successfully submit five error-free batches of 50 transactions for each transaction type you are testing. 
  4. Contact the EDI Help Desk and provide the Batch IDs for each of the successful end-to-end Batch IDs. 
  5. Upon end-to-end test file review, the EDI Help Desk will move your Submitter ID to Production. The Submitter ID can be utilized for sending transactions 24 hours from confirmation of a move to Production.

Note: EDI Companion Guides are on the EDI page of the TMHP website https://www.tmhp.com/topics/edi

 Additional Forms

 There are additional forms required for some EDI transaction types please see below: