eDMR Webinar Questions & Answers 1 Trading Partner Agreement must be submitted to DEP. You can find links to these forms on DEP’s eDMR website. eDMR Webinar Questions & Answers 2 in the eDMR system as described in the “eDMR GreenPort Registration User’s Guide.” eDMR User Guide Version 1.2, January 5, 2016. - 6 - the eDMR button if the Certifier(s) at the existing facility have not yet approved the association between the facility and the user’s account. Selecting a Facility. 1. Click in the “Facility Name” field. This Trading Partner Agreement (“TPA”) is entered into between ALABAMA MEDICAID AGENCY hereafter referred to as STATE and , a Billing Agent, a Health Care Clearinghouse, or a Vendor who transmits or receives any health information in electronic form in connection with a transaction covered by 45 C.F.R. Parts 160 and 162 (“Trading Partner”).

eDMR Trading Partner Agreement (3800-FM-BPNPSM0425): The Trading Partner Agreement Form is a formal agreement between each Certifier and DEP regarding the responsibilities and use of the eDMR system. Registration requires the creation of Greenport user accounts by the users, and is necessary to link those user accounts to a facility for eDMR use. To register for eDMR, you will need to submit the following documents to DEP: Registration Form; eDMR Trading Partner Agreement; The first page of your permit; All effluent limits tables in your permit; Blank copies of all DMRs issued with your permit; Submit these documents to DEP using the following address, fax number, or email address: Complete and submit an eDMR Trading Partner Agreement Form. This form is even easier than the first. It’s a simple one-page form that asks for a signature and that’s it. It basically states that you read and understand all the rules regarding electronic reporting; that you are a responsible official, that false reporting is a no-no, that eDMR Webinar Questions & Answers 1 Trading Partner Agreement must be submitted to DEP. You can find links to these forms on DEP’s eDMR website. eDMR Webinar Questions & Answers 2 in the eDMR system as described in the “eDMR GreenPort Registration User’s Guide.” eDMR User Guide Version 1.2, January 5, 2016. - 6 - the eDMR button if the Certifier(s) at the existing facility have not yet approved the association between the facility and the user’s account. Selecting a Facility. 1. Click in the “Facility Name” field. This Trading Partner Agreement (“TPA”) is entered into between ALABAMA MEDICAID AGENCY hereafter referred to as STATE and , a Billing Agent, a Health Care Clearinghouse, or a Vendor who transmits or receives any health information in electronic form in connection with a transaction covered by 45 C.F.R. Parts 160 and 162 (“Trading Partner”). A Trading Partner Agreement (TPA) is defined as a definitive and binding agreement between two trading partners for transacting messages over a specific B2B Protocol. Agreements bring together common bi-directional message processing properties from specific business profiles of both partners.

Complete and submit an eDMR Trading Partner Agreement Form. This form is even easier than the first. It’s a simple one-page form that asks for a signature and that’s it. It basically states that you read and understand all the rules regarding electronic reporting; that you are a responsible official, that false reporting is a no-no, that

eDMR Webinar Questions & Answers 1 Trading Partner Agreement must be submitted to DEP. You can find links to these forms on DEP’s eDMR website. eDMR Webinar Questions & Answers 2 in the eDMR system as described in the “eDMR GreenPort Registration User’s Guide.” By clicking on "I HAVE READ THE ELECTRONIC TRANSACTIONS TRADING PARTNER AGREEMENT AND I ACCEPT THE TERMS", you assent to be bound by the terms contained herein and also acknowledge your ability to bind the business entity specified on the approval page. I have read the Electronic Transactions Trading Partner Agreement and I accept the terms. Registration Form and Tradin g Partner Agreement to DEP’s Bureau of Clean Water (BCW), which is responsible for activating eDMR accounts. Both the eDMR Registration Form and Trading Partner Agreement can be accessed through DEP’s eLibrary site (www.depgreenport.state.pa.us/elibrary, select Forms – Clean eDMR User Guide Version 1.2, January 5, 2016. - 6 - the eDMR button if the Certifier(s) at the existing facility have not yet approved the association between the facility and the user’s account. Selecting a Facility. 1. Click in the “Facility Name” field. proprietor or a general partner; for a municipality, state, federal, or other public facility - the principal executive officer or ranking elected official. Service Agreement Establishes and documents the criteria required for functional access to various parts of the portal and associated facility/service-specific data.

eDMR Webinar Questions & Answers 1 Trading Partner Agreement must be submitted to DEP. You can find links to these forms on DEP’s eDMR website. eDMR Webinar Questions & Answers 2 in the eDMR system as described in the “eDMR GreenPort Registration User’s Guide.”

EDI Trading partner agreement. Geography, Letter. All - In order to exchange business documents electronically with IBM, either directly or through the use of a   ELECTRONIC TRADING PARTNER AGREEMENT. This Agreement is by and between all provider practices wishing to submit electronic claims to University  NASHVILLE, TENNESSEE 37247. Trading Partner Agreement. The Tennessee Department of Health, (hereinafter referred to as “TDH”), and Provider. Name:  Registration Form and Trading Partner Agreement to DEP's Bureau of Clean Water (BCW), which is responsible for activating eDMR accounts. Both the eDMR   This Agreement is by and between. (“Trading Partner”) and Hawaii Medical Service Association (“HMSA”), and is made effective on the date last signed below. eDMR Trading Partner Agreement (3800-FM-BPNPSM0425): The Trading Partner Agreement Form is a formal agreement between each Certifier and DEP regarding the responsibilities and use of the eDMR system. Registration requires the creation of Greenport user accounts by the users, and is necessary to link those user accounts to a facility for eDMR use. To register for eDMR, you will need to submit the following documents to DEP: Registration Form; eDMR Trading Partner Agreement; The first page of your permit; All effluent limits tables in your permit; Blank copies of all DMRs issued with your permit; Submit these documents to DEP using the following address, fax number, or email address:

eDMR Permittee Registration Form: Form: 3800-FM-WSFR0425: eDMR Trading Partner Agreement: Form: 3800-FM-WSFR0300: Emergency Response Plan* Form: 3800-FM-WSFR0405: Engineering Internal Review and Recommendations: Form: 3800-FM-WSFR0058a: Examinee Profile (Internal Use Only) Form : 3800-FM-WSFR0159: Experimental Drip Irrigation System Monitoring Record: Form

This Trading Partner Agreement (“TPA”) is entered into between ALABAMA MEDICAID AGENCY hereafter referred to as STATE and , a Billing Agent, a Health Care Clearinghouse, or a Vendor who transmits or receives any health information in electronic form in connection with a transaction covered by 45 C.F.R. Parts 160 and 162 (“Trading Partner”). A Trading Partner Agreement (TPA) is defined as a definitive and binding agreement between two trading partners for transacting messages over a specific B2B Protocol. Agreements bring together common bi-directional message processing properties from specific business profiles of both partners. This Trading Partner Agreement (“Agreement”) is made on between the Centers for of Medicare & Medicaid Services and . The Trading Partner (also known as the Submitter), intends to conduct eligibility transactions with CMS in electronic form.

any time without amendment to this Trading Partner Agreement, but the Trading Partner will not be required to implement such modifications sooner than 60 days after publication of the modified Specifications Addendum or Companion Guide, unless a shorter compliance period

eDMR Permittee Registration Form: Form: 3800-FM-WSFR0425: eDMR Trading Partner Agreement: Form: 3800-FM-WSFR0300: Emergency Response Plan* Form: 3800-FM-WSFR0405: Engineering Internal Review and Recommendations: Form: 3800-FM-WSFR0058a: Examinee Profile (Internal Use Only) Form : 3800-FM-WSFR0159: Experimental Drip Irrigation System Monitoring Record: Form eDMR Webinar Questions & Answers 1 Trading Partner Agreement must be submitted to DEP. You can find links to these forms on DEP’s eDMR website. eDMR Webinar Questions & Answers 2 in the eDMR system as described in the “eDMR GreenPort Registration User’s Guide.” By clicking on "I HAVE READ THE ELECTRONIC TRANSACTIONS TRADING PARTNER AGREEMENT AND I ACCEPT THE TERMS", you assent to be bound by the terms contained herein and also acknowledge your ability to bind the business entity specified on the approval page. I have read the Electronic Transactions Trading Partner Agreement and I accept the terms. Registration Form and Tradin g Partner Agreement to DEP’s Bureau of Clean Water (BCW), which is responsible for activating eDMR accounts. Both the eDMR Registration Form and Trading Partner Agreement can be accessed through DEP’s eLibrary site (www.depgreenport.state.pa.us/elibrary, select Forms – Clean eDMR User Guide Version 1.2, January 5, 2016. - 6 - the eDMR button if the Certifier(s) at the existing facility have not yet approved the association between the facility and the user’s account. Selecting a Facility. 1. Click in the “Facility Name” field. proprietor or a general partner; for a municipality, state, federal, or other public facility - the principal executive officer or ranking elected official. Service Agreement Establishes and documents the criteria required for functional access to various parts of the portal and associated facility/service-specific data. Trading Partner Agreement 5 What is a TPA? zHIPAA Section §160.103 Definitions of the final privacy rule includes this definition: – Trading partner agreement means an agreement related to the exchange of information in electronic transactions, whether the agreement is distinct or part of a larger agreement, between each party to the agreement.

any time without amendment to this Trading Partner Agreement, but the Trading Partner will not be required to implement such modifications sooner than 60 days after publication of the modified Specifications Addendum or Companion Guide, unless a shorter compliance period