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Division of Workers' Compensation

 


Electronic Data Interchange (EDI)

Form

Description

EDI Sender’s Trading Partner Profile

Form #WC170

Fillable pdf MS Word 

This is an EDI worksheet used by insurers to communicate to the Division, the Sender's contact information.

EDI Sender’s Transmission Profile

Form #WC169

Fillable pdf  MS Word 

This is an EDI form used by insurers to inform the Division of all allowable options in which data will be provided.

EDI Third Party Administrator Location List

Form # WC171

Fillable pdf MS Word 

This is an EDI  worksheet used by Third Party Administrators to provide the Division with Sender ID information in the header record of all EDI transactions.

EDI Trading Partner Insurer List

Form # 172

Fillable pdf MS Word 

This is an EDI worksheet used by Trading Partners to provide the Division with Sender ID information in the header record of all EDI transactions.

EDI Sender Acceptance Form

Form #WC175

Fillable pdf MS Word

This is an EDI form used by insurers in acceptance of the Colorado Electronic Data Interchange sender requirements.

 

 

 

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