Free EDI TRADING PARTNER PROFILE - New Mexico


File Size: 82.2 kB
Pages: 1
Date: February 20, 2008
File Format: PDF
State: New Mexico
Category: Workers Compensation
Author: lrollman
Word Count: 122 Words, 927 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://workerscomp.state.nm.us/pdf/e7.pdf

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NEW MEXICO WORKERS' COMPENSATION ADMINISTRATION

EDI TRADING PARTNER PROFILE
ATTN: STATISTICS PO BOX 27198 ALBUQUERQUE, NM 87125-7198
PLEASE PRINT IN BLACK INK OR TYPE

Reporting Purpose Code

PARTNER TYPE:

TPA Employer

Carrier Other

Service Bureau



Jurisdiction





Sender Administrator

TRADING PARTNER: Name: Mail/Address: City: Postal Code: Contact Person: Fax #: Phone: State: FEIN:

A49 (Sub. Report) Medical FREQUENCY OF REPORTING: Weekly Daily Bi-weekly
FILE TRANSMISSION: 148 (FROI)

Other Monthly Quarterly
POC

FILE TYPE:

ANSI



Flat File



Semi-Annually

Annually

DAY OF WEEK:

Sat. Sun. Mon.

Tue. Wed. Thur. Fri.

NETWORK: Production MAIL BOX ACCT. ID: USER ID: MESSAGE CLASS:
ORGANIZATIONS REPORTING UNDER SENDER ADMINISTRATOR:



Start Date Start Date_______________

Test

Insurer Name

FEIN

Type

Postal Code

Agreement Person

Title

Signature

Date

FORM WCA E7.1 (7/00)