OCAs Integrations Request Form

Integrations Request Form

Thank you for your request. Once this form is submitted an OCA representative will be in contact with your vendor to discuss the next steps.

Prior to completing this form please be sure that you have your vendor contact information and have spoken to your vendor to make them aware that OCA will be contacting them. OCA will not be able to process the integration request without this information.

Company Name *

Employer name/DBA with OCA

Person Requesting Integration *

Your Email *

example@example.com

Your Phone Number

Please indicate which OCA lines of service you wish to integrate with? *

HRA FSA/DCA COBRA Transit Parking HSA Other

Purpose of the file feed (please select all that apply) *

Eligibility Claims File Other

Purpose of the COBRA file feed (please select all that apply) *

New Hire File Qualifying Life Event File Other

"Vendor" name that will be sending/receiving files? *

i.e. Employee Navigator, ADP, etc.

Vendor Point of contact

First Name Last Name

Vendor Email *

example@example.com

Phone Number

Requested "Go Live" Date of File Connection *

Date

Status

Submitted