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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

If you are not using TexMedConnect or one of our Approved Vendors, follow the steps below to establish an active EDI account and sign up for EDI with Texas Medicaid.

  1. Download and complete the following forms:
  2. Mail all documents to: 

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

Note: Allow up to 30 days from date of receipt for processing.

After the EDI Help Desk has received all the required forms and agreements, a Submitter ID will be assigned for end-to-end system testing.

Note: Your submitter ID will only be valid in the Test environment until it has been approved for Production.

  1. Download the TMHP EDI Connectivity Guide, which outlines the steps and requirements for establishing a connection with Texas Medicaid. It includes details for sending and receiving files in both the Test and Production environments.
  2. Complete end-to-end testing in the TMHP Test environment. All trading partners must successfully submit five error-free batches of 50 transactions for each transaction type they are testing.
  3. Contact the EDI Help Desk and provide the Batch IDs for each of the successful end-to-end Batch IDs.

After the end-to-end test file review, the EDI Help Desk will move your Submitter ID to Production. You can begin sending transactions within 24 hours of receiving confirmation of the transition.

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: