Get Medical Edi Compliance Coordinator Tdi Form

Completing the Medical Edi Compliance Coordinator Tdi Form is a vital step for insurance carriers to report electronic data interchange needs. This guide provides a clear, step-by-step approach to filling out the form online, ensuring compliance and facilitating efficient processing.

Follow the steps to fill out the Medical Edi Compliance Coordinator Tdi Form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In Section I, enter the insurance carrier's name, federal employer ID number (FEIN), and TXCOMP customer number. Ensure all information is accurate for proper identification.
3. In Section II, provide the Medical EDI Compliance Coordinator's details, including their full name, phone number, working title, fax number, mailing address, and email address. This section is crucial as it identifies the individual responsible for EDI reporting.
4. In Section III, indicate whether you are adding or removing trading partners. Fill in the effective date, trading partner's name, and their FEIN. Repeat this for each trading partner as necessary, ensuring all changes are reported within five working days.
5. In Section IV, the compliance coordinator must affirm their understanding of EDI requirements by signing and dating the form. This signature serves as acknowledgment of accountability for trading partner actions.
6. After completing all sections, review the form for accuracy. Once satisfied, save your changes. You may then download, print, or share the form as needed.

Complete your forms online to ensure efficient processing and maintain compliance with EDI regulations.