EDI (Electronic Data Interchange)

What Is EDI?

EDI is the computer-to-computer exchange of standard business data between companies and the Commonwealth of Pennsylvania. Generally used within the workers' compensation insurance community to exchange accident, payment, insurance and medical information, EDI permits the transfer of large volumes of information more efficiently and accurately than in paper form.

Who submits EDI transactions to the Bureau of WC?

Trading partners are the insurance claim administrators who use EDI to report claim data to the bureau.
 
Transaction partners are organizations selected by the bureau to accept and forward EDI claim transactions from trading partners to the bureau.
 
Direct filing is the process of submitting EDI transaction files directly to the bureau without using a transaction partner.

How to Get Started

Before using EDI, trading partners and direct filers must review the Pennsylvania EDI Implementation Guide and complete the bureau's Trading Partner Agreement.
 
Bureau acceptance of First Reports and Subsequent Reports using EDI is contingent upon receipt of a properly completed Trading Partner Agreement Packet, including a signed agreement and successful testing. The bureau will issue a letter to all new partners upon successful implementation.
 
There are three methods for insurance carriers, third-party administrators and self-insured employers to submit EDI transactions to the bureau:
  1. By way of the EDI Web portal via the user’s WCAIS dashboard. Companies interested in this option must submit a completed Web portal Trading Partner Agreement as well as register to use the Workers’ Compensation Automation and Integration System or WCAIS.
     
  2. Use of a transaction partner. Companies interested in submitting transactions using this option must complete a Trading Partner Agreement.
     
  3. Interested companies may also apply to become a Pennsylvania direct filer. To be added to the waiting list to become a direct filer, companies must meet criteria and submit an application.

Training Resources

 
For more information on Pennsylvania's EDI program, see the links on the left navigation bar, or contact:
EDI Business Coordinator
Email: RA-CMDEDI@pa.gov
Phone: 717-886-9182
Fax: 717-705-1629

EDI Standards

The Bureau of Workers' Compensation uses the Claims Release 3 EDI standards developed by the International Association of Industrial Accident Boards and Commissions (IAIABC), a private association of workers' compensation professionals from private and public sectors with a basic objective to strengthen and improve the administration of workers' compensation law globally.
 
For more on the IAIABC:
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