EDI Transmission Profile-Sender Specifications {EDI-3} | Pdf Fpdf Doc Docx | Florida

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EDI Transmission Profile-Sender Specifications {EDI-3} | Pdf Fpdf Doc Docx | Florida

EDI Transmission Profile-Sender Specifications {EDI-3}

This is a Florida form that can be used for Workers Comp.

Alternate TextLast updated: 5/2/2006

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Description

Florida Division of Workers Compensation EDI Transmission Profile Sender Specifications PROFILE ID**: ______________________________________ Date: ___________________ **Obtain six character code from Division if sending data files via FTP SENDER NAME : ___________________________________________________________ SENDER IDENTIFIER: ___________________SENDER POSTAL CODE: ______________ TRADING PARTNER TYPE: ___Claims Admin ___ Insurer ___ Third-Party Vendor TRANSACTION SET INFORMATION TRANSACTION INFORMATION ACKNOWLEDGMENT INFORMATION Projected Transmission Type Format Release Number Per Mode Level IAIABC Transaction POC Flat File 2.0 EDI All 148 Flat File 1.0 EDI All A49 Flat File 1.0 EDI All TRANSMISSION FREQUENCY INFORMATION CHOICES Daily Other Describe: Selected Media Proof of Coverage: Internet Transfer Protocol only Claims: ____FTP ____VAN If VAN Selected: Network: _________________ ______________________ Production Pilot/Test Mailbox Acct ID: ____ _____ ________ User ID: _ ________ ________ Message Class: _________ ________ INTERCONNECT NETWORK: __ _____________________ Transmission Payments: ___ Each _XX_ All ___ None Please e-mail completed form for: Proof Of Coverage to: pocedi@dfs.state.fl.us Claims to: clmsedi@dfs.state.fl.us DWC Form EDI-3 (3/02)

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