837 Health Care Claim Technical Procedures And Infrastructure (IEHP Provider Network)
837 Health Care Claim: Professional Transaction must be transmitted by business partners to IEHP by connecting to the IEHP Network. They go from the Internet through a Virtual Private Network (VPN) tunnel to the IEHP Secure File Transfer Protocol (SFTP) Server. In standard software-to-hardware VPN connections, VPN client software is installed and configured on each machine at the client site that requires SFTP access. Business partners can contact IEHP for more information on establishing connections through the SFTP Server.
IEHP Functional Acknowledgement/Reports
TA1 – Interchange Acknowledgement
The TA1 report enables the receiver to notify the sender when there are problems with the interchange control structure. As the interchange envelope enters the EDFES, the EDI translator performs TA1 validation of the control segments/envelope. The sender will only receive a TA1 if there are syntax errors in the submitted file. Errors found in this stage will cause the entire X12 interchange to reject with no further processing IPA will receive a TA1 interchange report acknowledging the syntactical inaccuracy of an X12 interchange header ISA and trailer IEA and the envelope’s structure. Encompassed in the TA1 is the interchange control number, interchange date and time, interchange acknowledgement code and interchange note code.
999 – Functional Acknowledgment
The 999 Acknowledgement may produce three (3) results:
1. Accepted (A)
2. Rejected (R)
3. Accepted with errors (E)
As a result, the 999 may acknowledge receipt of a transaction, such as a healthcare claim, but it does not necessarily mean that transaction will be processed. The 999 can also report on exactly what syntax issues caused the errors in the original transaction.
EVR – Encounter Validation Response (EVR) Extensible Markup Language (XML) files
The response files will provide details on whether a file was accepted or rejected and whether an encounter data record was accepted or denied. If errors were found in the encounter data files submitted, it will result in a rejected file and/or denied encounter data record.