Proof Of Coverage EDI Transmission Profile {4979}

4979 - PROOF OF COVERAGE EDI TRANSMISSION PROFILE. This form is used by insurers or third-party vendors to provide the state with required electronic data interchange (EDI) information regarding workers’ compensation coverage. The form collects details about the sender, including legal name, Federal Employer Identification Number (FEIN), IP address, physical and mailing addresses, and contact information. It also specifies the type of transmission being submitted (such as daily transmissions of proof of coverage), the file format (IAIABC Flat File Release 2.1), and the method of transmission, which must be Secure File Transfer Protocol (SFTP) compatible with Open Secure Shell (SSH), Version 2 Protocol. The form ensures that the sender is properly registered and configured to transmit proof of coverage data to the Oregon Workers’ Compensation Division. Completed forms must be submitted to the EDI Coordinator by mail, fax, or email. www.FormsWorkflow.com