Medical Electronic Data Interchange Profile

Auto Response Email:

Upon the completion of the updated Medical EDI Trading Partner Profile online, an auto response email will be sent to the primary contact, and to the jurisdiction. This will serve as notification, to all parties, of the EDI Trading Partner information for EDI implementation. Upon approval of the EDI Trading Partner Profile by North Carolina Industrial Commission (NCIC), the EDI Support Team will contact the primary contact to indicate when the update will become effective for EDI reporting.

NCIC Master FEIN 561611847 for EDI Reporting

Note: Required fields are indicated in bold.

EDI Sender/Receiver (Primary Insurer/TPA):

Update
NC

The Company Name of the sender should be the entire name as listed on any licensing/registration applications filed with the North Carolina Industrial Commission and not an acronym.
(nine digit FEIN, no punctuation)
(nine digit postal code)

Preparer Contact Information:


(one method required)

Primary Contact for EDI Implementation/Setup:

 




Secondary Contact:

 





Subsidiary Insurer(s):

If applicable, provide the Insurer FEIN, Insurer full Legal Name, Insurer Type, Status, and Status Effective Date for whose claims the Sender (Primary Insurer/Trading Partner) will be transmitting data. To add a new subsidiary Insurer or to remove a subsidiary Insurer that was already submitted, click on the Add/Remove Subsidiary button, indicate Add or Remove and enter the applicable subsidiary information.


Claim Administrators(s):

If applicable, provide the Claim Administrators information below including the physical address and mailing address that will correspond to the Claim Administrator recorded on the claim(s) that will be reported by the Sender (Trading Partner) that will be transmitting data. To add a new Claim Administrator or to remove a Claim Administrator that was already submitted, click on the Add/Remove Claim Admin button, indicate Add or Remove and enter the applicable claim administrator information.