TRANSACTION STANDARD TRADING PARTNER AGREEMENT/ADDENDUMTrading Partner Agreement • January 26th, 2011
This Trading Partner Agreement (“TPA”) is entered into between HP Enterprise Services (“HP”), as an agent for the Connecticut Department of Social Services (“DSS”) and , a Billing Agent, a Health Care Clearinghouse or a Provider who transmits any health information in electronic form in connection with a transaction covered by 45 C.F.R. Parts 160 and 162 (“Trading Partner”). If the Trading Partner is a Provider participating in the Connecticut Medical Assistance Program, this TPA is made an addendum to the Provider Enrollment Agreement on this day of , 2011.