Electronic Data Interchange Profile

Upon the completion of the 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 system setup. The primary contact will be contacted to coordinate implementation and scheduling.

Required fields are indicated in bold.

EDI Sender/Receiver (Primary Insurer/TPA):

New
OIC

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

Preparer Contact Information:


(one method required)
WVOIC 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 oicwvcustomercare@wv.gov
Comments:

Primary Contact for EDI Implementation/Setup:

 

Secondary Contact:

 

Subsidiary Insurer(s):

This section is designed to include the entities of trading partners using the same Third Party Administrator (TPA) or other sender to transmit data electronically to the jurisdiction. For each additional insurer added, the appropriate Claims Index Contact must be added also.

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