FROI-SROI Electronic Data Interchange Profile

Auto Response Email:

Upon the completion of the FROI-SROI 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 coordinate implementation and scheduling. Trading Partner Profile updates submitted Monday through Friday on a given work week will be processed and available Monday of the following week.

NCIC Master FEIN 561611847 and Postal Code 276994340 for EDI Reporting

Note: Required fields are indicated in bold.

EDI Sender/Receiver (Primary Insurer/TPA):

New
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)
NCIC does not endorse, nor recommend any one vendor over another. If you do not see your EDI Vendor or if you are an EDI vendor and would like to be added to this list, please send an email to ncicedi@ic.nc.gov
Comments:

Primary Contact for EDI Implementation/Setup:

 




Secondary Contact:

 





Subsidiary Insurer(s):

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.

(1)
(mm/dd/yyyy)
(nine digit FEIN, no punctuation)
 

Claim Administrators(s):

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.

(1)
(mm/dd/yyyy)
(nine digit FEIN, no punctuation)
(nine digit postal code)
(nine digit postal code)