Trading Partner Profile EDI

Trading Partner Profile Trading Partner Type: Carrier Third Party Administrator Sender Name: Sender's FEIN: Physical Address: City: State Postal Code: Mailing Address: City: State: Postal Code: Contact Information: Name: Title: Phone: Fax: E-mail: Business Contact: Technical Contact: Employer Service Bureau Sender's Postal Code: (Must have 9 digits) Transmission Profile ­ Sender's Response Receiver Name: Master FEIN: State of Montana, Employment Relations Division 81-0302402 Postal Code: 59604-8011 Transaction Information: Transactions 148, A49, AK1 ­ Flat File Release (IAIABC Claims Release 1) Transmission Frequencies: May transmit Sunday through Saturday. Acknowledgments processed Monday Friday. Select one: Electronic Mailbox(s) for this Profile: EBIX (formerly Claims Harbor/Claimport) IVANS/Advantis Mitchell Regulatory Reporting Solutions Health Tech ISO wcPrism Solutions Direct Reporting sFTP DLI-ERD-WCC024 Revised 4/19/12de American LegalNet, Inc. www.FormsWorkFlow.com