Form 4821: Oregon Proof of Coverage EDI Insurer Profile is a form to be completed and submitted by insurers to the Oregon Department of Consumer and Business Services. It is used to provide the insurer's electronic data interchange (EDI) profile information, which is required for the insurer to participate in Oregon's electronic submission process for proof of coverage filings. This form is divided into two parts: Part A is for health insurance carriers, and Part B is for property and casualty, life, and annuity carriers. The form is used to provide information about the EDI software used by the insurer, the EDI contact information, and the EDI transaction set information.
Form 4821: Oregon Proof of Coverage EDI Insurer Profile
State:
Oregon
Control #:
OR-SKU-1824
Format:
Word
Instant download
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Description
Form 4821: Oregon Proof of Coverage EDI Insurer Profile
How to fill out Form 4821: Oregon Proof Of Coverage EDI Insurer Profile?
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