Please follow the Enrollment Instructions below to become an electronic submitter for Oregon Medicaid.

Required Documents for those applying for new Submitter IDs

The following documents are required enrollment documents that must be completed, signed and returned to the Oregon Medicaid office prior to initiation of electronic claims submission or inquiry.

(Important Note: Please make sure the email addresses you enter on the form are individual email addresses, not one that might be considered a "group" email address.)

1. Trading Partner Agreement

If the links above do not work properly, please download the forms directly from the website:

www.oregon.gov/OHA/edi

If you have any questions regarding any of the documents in this package, please phone the Oregon Medicaid EDI Technology Support Center at 1-800-527-5772.

We can now process 276/277 requests (claim status). If this is a transaction you would like to utilize please make sure to enroll with the payer.

Trading Partner Agreement

• Please select "Fully replaces the current TPA on file... "
• Check the box that most accurately describes your organization (provider or clinic)
• Enter the primary and secondary authorized signers information
• Enter a primary and secondary claims contact
• Enter "Self" in the Submitter Name field then enter your address, city, state, and zip
• Skip the Submitter Mailbox # section
• Enter the business contact and technical contacts information
• For authorized transactions select the following:
  • Professional Claim Submission if you send professional claims (CMS 1500)
  • Institutional Claim Submission if you send institutional claims (UB 04)
  • Electronic Remittance Advice if you want to receive your remittance advice (EOB's) electronically
• Please have the appropriate contacts in your office sign the bottom of the form

Submitting your Forms

It is recommended that you keep a copy of all the forms you will be submitting for your records. Mail the enrollment forms reflecting original signatures to:

EDI Support Services
500 Summer St. NE Salem, OR 97301-1079

It is very important that you complete and return the entire enrollment packet as described above. Incomplete packets will not be processed and will be returned to the submitter.

Waiting for a Response

Once the complete provider enrollment packet has been received, the documents will be processed. Processing will take approximately two weeks from the date of receipt. (Remember that mailing time can take as much as five days.)

After processing, a confirmation will be faxed to you as notification to begin filing claims electronically. If neither confirmation nor a returned packet is received after two weeks, contact the Oregon Medicaid EDI Technology Support Center at 1-800-527-5772.

Testing

Once you have received your Submitter ID and password from Medicaid, please call the ClaimShuttle Support Team and set an appointment for a Mailbox setup and Test Transmission.

Please have 25 test claims ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.