Trading Partner Agreement
This Agreement is by and between the Medical Care Program (Medicaid) and
PROVIDER NAME PROVIDER ADDRESS
__________________________________, hereafter known as the Provider.
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[If applicable] the Provider and Program hereby agree that the Provider may use a
certified clearinghouse (Submitter Agent),
SUBMITTER AGENT NAME SUBMITTER AGENT ADDRESS
__________________________________, hereafter known as Submitter Agent, to
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transmit HIPAA transactions arising from the Provider’s participation in the Program.
1. Purpose of Agreement- This agreement is intended to facilitate communications
between the Program and the Provider in the processing by the Program of
electronic transactions filed by or on behalf of the Provider.
2. Provider Submission of transactions- The Provider shall submit all data
transmissions pursuant to Program standards. The Provider hereby warrants that
all data will be submitted in compliance with the Program’s regulations,
transmittals, and any provider manual(s) specific to the provider. The Program
reserves the right to modify its regulations, transmittals and other manuals at any
time and to notify Provider of those changes by electronic communication. The
Program reserves the right to reject any transaction which does not conform to its
data submission standards.
3. Program Acceptance of Electronic Transactions
- The Program agrees to accept
valid transactions submitted by the Provider or the Submitter Agent.
4. Cooperation with Testing- During the testing phase, as designated by the
Program, both Program and Provider agree to cooperate with each other, and with
entities performing business associate type functions for the contracting parties,
for the purpose of striving for accuracy, timeliness, security and completeness of
5. Use of Standard Transactions and Code Set Format- HIPAA regulations, at 45
CFR Part 162 HIPAA Federal Electronic Transactions and Code Sets for Data
Exchange, provide for certain transaction standards for transfer of data between
trading partners. The Provider must submit and the Program will be prepared to
accept, translate, or route HIPAA compliant transactions. As HHS modifies the
standards, the trading partners agree to incorporate by reference any modifications
or changes to 45 CFR Part 162.