Electronic Data Interchange Overview

Electronic Data Interchange (EDI)

Provider Electronic Solutions (PES)

TRADING PARTNER TESTING VERIFICATION COMPLETION INSTRUCTIONS

The Division of Health Care Financing (DHCF) requires certain information to enable the DHCF to certify providers and to authorize and pay for medical services provided to eligible recipients of DHCF health care programs.

Personally identifiable information about DHCF providers is used for purposes directly related to health care program administration, such as determining the certification of providers or processing provider claims for reimbursement. Failure to supply the information requested by the form may result in denial of payment for the services.

The use of this form is mandatory. The Division of Health Care Financing (DHCF) Electronic Data Interchange (EDI) department will not accept other versions (i.e., retyped or otherwise reformatted) of this form.

INSTRUCTIONS

Return the completed form to the EDI department by mail at the following address or by fax at (608) 221-0885:

Division of Health Care Financing
EDI Department
6406 Bridge Rd
Madison WI 53784-0009

Faxed forms should be sent to the attention of the EDI department.

Purpose of testing verification form

The DHCF requires trading partners to complete the testing verification form as the final step in the EDI enrollment process. The DHCF EDI department must receive and process the testing verification form before approving trading partners to exchange production transactions. These instructions pertain to the following transactions:

• X12 270/271 Health Care Eligibility Benefit Inquiry/Response.
• X12 837 Health Care Claim: Dental, Institutional, and Professional.
• X12 TA1 Interchange Acknowledgement.
• X12 997 Functional Acknowledgement.
• X12 835 Health Care Claim Payment/Advice.

Trading partners are not required to complete testing of each applicable transaction simultaneously and may submit multiple forms to the DHCF EDI department as the applicable transaction testing is completed. The DHCF EDI department will notify trading partners as additional transaction testing requirements and instructions become available.

Testing requirements

The DHCF requires trading partners, including users of the free claims submission software, Provider Electronic Solution (PES), to complete specific testing before exchanging production transactions. Refer to the table below to determine who is required to test.

SECTION I — TRADING PARTNER INFORMATION

For each of the following fields, enter the trading partner contact information.

Name — Trading Partner
The trading partner identification number is an eight-digit number assigned by the EDI department. Refer to Section II of these instructions for more information on obtaining a trading partner identification number.

SECTION II — TESTING VERIFICATION CHECKLIST

Indicate, by placing a check mark in the corresponding box, that the trading partner has completed the applicable testing requirement.

Completed Trading Partner profile form and received trading partner identification number

Trading partners, including PES users, must complete a Trading Partner Profile before exchanging transactions with the DHCF EDI department. The trading partner profile form and instructions are located on the Medicaid Web site at dhfs.wisconsin.gov/medicaid9/edi/edi.htm. The DHCF EDI department will assign a trading partner identification number and notify trading partners after the Trading Partner Profile has been received and processed.

Completed EDI pre-testing

The DHCF requires trading partners intending to exchange the X12 837 Health Care Claim: Dental, Institutional, or Professional to pre-test using the DHCF EDI Communedi online testing service, except for trading partners exclusively using the PES software. PES users may skip to the next step. There is no cost to trading partners to complete the pre-testing.

The DHCF EDI department will be automatically notified after a trading partner has passed the criteria established by the DHCF for submitting health care claims. Trading partners may access the DHCF EDI Communedi online testing service at wiedi.communedi.com/. See Attachment I of these instructions for more information regarding the DHCF EDI Communedi testing service.

Completed EDI user registration

Trading partners, including PES users, must complete the user registration online form located at the DHCF EDI Web site at www.wisconsinedi.org/. See Attachment II of these instructions for more information regarding user registration.

Connected and exchanged applicable transactions

The DHCF requires trading partners, including PES users, to connect and exchange transactions with the EDI department as the final testing requirement prior to being approved for production. Trading partners must connect and exchange the transactions indicated on the Trading Partner Profile form submitted to the DHCF EDI department in order to be approved for production. See Attachment III of these instructions for EDI connectivity and exchange instructions.

SECTION III — INDIVIDUAL COMPLETING FORM

For each of the following fields, enter the information for the individual responsible for completing the DHCF EDI Trading Partner Testing Verification form. Forms that are not signed and dated will be returned.

Name — Individual Completing Form
Telephone Number — Individual Completing Form
Fax Number — Individual Completing Form
E-mail Address — Individual Completing Form
Signature — Individual Completing Form
Date Signed

SECTION IV — OFFICE USE ONLY

Do not write in this section.