The State of North Dakota, acting through Workforce Safety & Insurance (the STATE) is soliciting proposals for existing electronic data interchange (EDI) clearinghouse vendor(s) for medical providers who wish to process workers’ compensation (WC) medical billing, medical documentation, and payment transactions. WSI is soliciting proposals from vendors who will provide an established electronic data interchange (EDI) clearinghouse for medical providers who wish to process medical billing, medical documentation, and payment transactions for workers’ compensation (WC). The objective of this initiative is to replace the number of paper filings with electronic transactions to improve the quantity and quality of data captured. WSI is expecting to outsource this service to multiple vendors (i.e. clearinghouses) who have successfully implemented WC EDI solutions for other states or payors. Expanding these capabilities with multiple vendors will expand utilization of this billing format by medical providers treating work injuries covered by the state’s workers compensation system. The International Association of Industrial Accident Boards and Commissions (IAIABC) established standards for WC EDI through a workers’ compensation model rule and companion guide, which incorporate ANSI ASC X12N standards. WSI expects the vendor to accommodate the standards outlined in these documents for EDI of medical billing, medical documentation, and payment transactions. A vendor must demonstrate the vendor is a member in good standing of the IAIABC and has actively participated in the EDI activities of healthcare and insurance providers for more than one year.
