Or. Admin. Code § 436-162-0060 - Testing Procedures and Requirements

Proof of coverage testing:

(1) The director adopts the Oregon EDI Implementation Guide for Proof of Coverage as the standard for EDI testing procedures and requirements, available from the division's website: http://www.cbs.state.or.us/wcd/operations/edi/ediindex.html#bill [File Link Not Available].

(2) Senders conducting EDI transactions as of Jan. 1, 2009, do not have to complete EDI testing. Insurers using an approved EDI vendor to submit proof of coverage data to the department do not have to complete testing as provided by this rule.

(3) Senders must obtain director approval to submit proof of coverage data via EDI transactions. Each sender must successfully complete the Secure File Transfer Protocol (SFTP) test and the format and structure test(s) detailed in the Oregon EDI Implementation Guide for Proof of Coverage to demonstrate ability to successfully transmit coverage data in the format specified in OAR 436-162-0004. The director will notify senders once they have successfully completed testing. Insurers must either use an approved sender or be approved as a sender to report proof of coverage via EDI. If an insurer is not an approved sender, it must report through an approved sender until approved by the director for direct reporting of proof of coverage via EDI.

Notes

Or. Admin. Code § 436-162-0060

WCD 7-2010, f. 10-1-10, cert. ef. 1-1-11

Stat. Auth: ORS 656.726(4)

Stat. Implemented: ORS 84.013, 656.264