Free untitled - Florida

FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION

EDI TRANSMISSION PROFILE - SENDER'S SPECIFICATIONS
IMPORTANT: Complete all fields designated with an asterisk ( * ). Form will be returned if any required fields are missing.

Return this page to: Date Receiver Name: Florida Department of Financial Services, Division of Workers' Compensation [email protected] or [email protected] E-mail: Sender Legal Name* (no abbreviations): Insurer Self-Insurer Sender Type*: Sender ID ­ FEIN*: Transaction Information
TYPE
Release/ Version

Third Party Administrator Vendor (POC Only) Postal Code* (9 digits): Acknowledgment Information AcknowledgMode Prod ment Record Response AKP EDI Next bus day AKC EDI Next bus day AKC EDI Next bus day

MTC's* N/A

ANSI

ANSI Ver

Projected # per Transmission*

POC FROI SROI

2.1 3.0 3.0

N/A N/A N/A

N/A N/A N/A

Transmission Frequency*(select only one option from the "EDI Transmission Profile - Receiver's Specifications") Daily Weekly ­ Specify Day(s): SUN MON TUE WED THU FRI SAT
Transmission Cut-off Time (military): 2100 EST

Jurisdiction Approved Transmission Method*(select only one option from the "EDI Transmission Profile Receiver's Specifications") If VAN is used, provide the below required Electronic Mailbox information*. Network (VAN) FTP Electronic Mailbox: Network: ADVANTIS Test Production Mailbox Acct ID: User ID: Message Class: Transmission Payments: Sender will assume all costs associated with sending and receiving transactions Vendor (if applicable)* Vendor Name File Transfer Protocol: Web Site IP Address/URL: See Trading Partner FTP instructions for detailed information User ID: Security Protocol: Secure Socket Layer (SSL) recommended Certificates: Bi-Directional Exchange of digital certificates recommended Auditing: Non-repudiation is recommended, i.e., the system must have an auditable tracking of transfers to/from each trading partner Encryption Level: 112 bit minimum recommended

Receiver Requirements See FL Secure Socket Layer (SSL) / File Transfer Protocol (FTP) Instructions Assigned by DWC Required - See FL Secure Socket Layer (SSL) / File Transfer Protocol (FTP) Instructions Required - See FL Secure Socket Layer (SSL) / File Transfer Protocol (FTP) Instructions Required - See FL Secure Socket Layer (SSL) / File Transfer Protocol (FTP) Instructions 128 bit - See FL Secure Socket Layer (SSL) / File Transfer Protocol (FTP) Instructions

Draft DFS-F5-DWC-EDI-3 (10/01/2006)