VWC requires each entity, including those who plan to use a service provider, to complete the Electronic Trading Partner Profile. The Trading Partner Profile provides pertinent information about the sender including their legal name, address information, FEIN and contact information. The information contained in this document is used to set your organization up in the Commission’s Claims Processing System, as well as our Vendor’s system. The VWC also uses the contact information listed when we need to make an inquiry or ask a question pertaining to your organization’s EDI transmissions.
This document must be fully completed in order for your organization to be approved for production in Virginia. Please complete each of the following sections:
- Trading Partner Type – Please select which party you are. In most cases, you will either be (but can be more than one) the Insurer (only if you administer your own claims), Third Party Administrator or EDI Service Provider. However, if you are a self-insured employer who also administers their own workers’ compensation claims, you will not be either of those two and should select both Employer and Self-Insurer.
- Legal Name: Please provide the legal name of the entity submitting the EDI Transactions to VA.
- Sender ID: Please provide the Federal Employer Identification Number (FEIN) and Postal Code of the entity listed above (Legal Name).
- Physical Address: Please provide the Physical Address (main headquarters location) for the entity listed under Legal Name.
- Mailing Address: Please provide the mailing address where you would want all claims related correspondence to be mail. Please note: each organization can only have one address per FEIN provided. The Commission can no longer accommodate multiple addresses for each Claim Administrator unless there is a different FEIN for each location.
- Contact Information: Please provide the Business and Technical Contact information along with the information for the individual who prepared this document.
This form may be filed with the Commission in the following ways:
- EMAIL: Email the completed forms to firstname.lastname@example.org. Please add “Trading Partner Documents” as the subject.
- FAX: Fax the complete form to 804-418-4919 with Attention: EDI QA Department
- MAIL: Mail the completed form to 333 E. Franklin St., Richmond, VA 23219 with Attention: EDI QA Department
For questions, please contact the Commission toll-free at 1-877-664-2566 and ask for the EDI QA Department or by email at email@example.com.