TRADING PARTNERS
The bureau's acceptance of EDI transactions is contingent upon a properly completed Trading Partners Profile, successful testing, and bureau approved Trading Partner Agreement Application in WCAIS. The bureau will notify new partners when these requirements have been satisfied.
Additional information may be obtained by contacting the bureau's EDI Section via the customer service "Submit a Question" feature from the WCAIS dashboard.
All Trading Partners must annually review and rectify the Trading Partner Agreement Application in WCAIS. If contacts, Claim Administrators, or Submission Methods change in between the annual reviews, Trading Partners are required to either amend the current Trading Partner Agreement Application or submit a new Trading Partner Agreement Application for bureau staff to review and approve.
Trading Partners opting to utilize the Flat File Submission Methods (Transaction Partner or as an approved Direct Filer) will not be able to use the Pennsylvania WCAIS EDI Web Portal to submit EDI transactions.
TRANSACTION PARTNERS
The Bureau of Workers' Compensation requires all Trading Partners to submit EDI transactions to the bureau using one of its approved EDI Transaction Partners. The bureau will verify that each EDI Transaction Partner is qualified to send and receive data utilizing the IAIABC EDI Release 3 format that meets the requirements set forth by the
EDI Questionnaire, the
Transaction Partner Testing Requirements document, and within the bureau's Claims EDI Implementation Guide. All requests to be added to the list of EDI Transaction Partners must include a completed copy of the EDI Questionnaire attesting to the ability to meet all Transaction Partner requirements.
The bureau requires all Trading Partners to submit EDI transactions using one of its approved EDI Transaction Partners. Only EDI transactions coming from these organizations will be accepted.
The basic requirements for becoming an approved EDI Transaction Partner in Pennsylvania are:
- Organization must be in the business of trading in EDI Claims Release 3 on behalf of others.
- Organization must have experience trading in IAIABC Claims Release 3 format in other jurisdictions.
- Organization must be able to supply a data feed in either flat or XML format (as specified by L&I).
- Organization must provide an online portal option to allow small businesses to submit EDI data.
- Organization must be an active IAIABC EDI member.
If, after testing, it is determined that a Transaction Partner cannot process data as required or has not maintained standards set forth in the
Transaction Partner Testing Requirements document (such as maintaining at least a minimum 85 percent acceptance rate for SROIs and 90 percent acceptance rate for FROIs), Implementation Guide and Appendices, it may result in dismissal as an approved Transaction Partner. Any Transaction Partner dismissed from the list will have to re-apply through the standard process to again become an approved EDI Transaction Partner. All Transaction Partners agree to comply with testing time frames as outlined by the bureau.
Approved EDI Transaction Partners
Ebix Inc.
Business address: 10 Tenth Street, NE, Atlanta, GA 30309-3848
Contact: Kevin Newlin
Contact telephone number: 404-418-9886
Contact email address:
Kevin.Newlin@ebix.com
HealthTech Inc.
Business address: 11730 W. 135th Street, Suite 31, Overland Park, KS 66221
Contact telephone number: 913-764-9347 x112
Contact email address:
mhughes@htedi.com
Insurance Services Office Inc.
Business address: 545 Washington Boulevard, Jersey City, NJ 07310
Contact: Ellen Heiber
Contact telephone number: 813-505-8432
Contact email address:
Ellen.Heiber@Verisk.com
Mitchell/Enlyte
Business address: 12255 El Camino Real, Suite 300, San Diego, CA 92130
Contact: ExecutiveEnlyte Sales Team
Contact telephone number: 866-389-2069
Contact email address:
hello@enlyte.com
Aerie EDI Group
Business address: 315 Kennedy Road, Chase City, VA 23924
Contact: Pat Cannon
Contact telephone number: 434-509-4494
Contact email address:
patc@aerieedigroup.com
Riskonnect Inc.
Business address: 1212 Ross Street, Amarillo, TX 79102
Contact: Jeremy King
Contact telephone number: 806-282-6624
Contact email address:
jeremy.king@riskonnect.com
DIRECT FILERS
A Trading Partner can submit EDI transactions directly to the bureau by placing their files at the Department of Labor & Industry's SFTP location without using a Transaction Partner. Trading Partners must fulfill the Direct Filer's
criteria and complete all testing requirements successfully.
NOTE: The testing window for Direct Filers is currently closed and will reopen at a later date. New requests for direct filing status in PA, submitted along with the required Direct File documents, are added to the list of Direct Filers to be tested at a later date. (Requests submitted without the required documents will be returned not processed.) When the testing process reopens, applicants will be contacted in the order requests were received.
In the interim, insurers have the option to use one of the existing EDI-approved transaction methods including the EDI claims Web portal or one of the approved EDI Release 3 Transaction Partners.
Questions can be directed to the bureau's EDI Section via the Customer Service Center “Submit a Question” feature from the WCAIS dashboard.
ORGANIZATIONAL HIERARCHY
Companies may submit a request to add a new business unit (or several) to their profile in WCAIS if new offices have been added. Additionally, parent companies with multiple subsidiary organizations may submit a request to add new subsidiary organizations.
How-To Guides, which describe the steps necessary to request the new associated business unit or subsidiary organization, can be found on the "Insurer and TPA Training Resources" page. Click the following link and scroll down to the section
Key Communications and Helpful Documents.