Proof of Coverage EDI Transmission Profile Forms
| Form Name | Proof of Coverage EDI Transmission Profile |
| Form # | 440-4979 |
| Form Revision | 3/24 |
| Category | Forms » Board/Commission/Division |
| Downloads | |
| Form State | Oregon |
| Language | English |
| State Description | For use by insurers and self-insured employers to submit proof of coverage EDI. |
| Claimwire Description | n/a |