EDI 837 Dental Healthcare Claim

EDI 837 Dental Healthcare Claim Set-up, Directory and File Naming Notes

EDI 837 Dental Healthcare Claim set-up requires establishing connections through the SFTP server with further instructions on SFTP usage.

SFTP Directory Naming Convention

There would be two categories of folders under Trading Partner’s SFPT folders:

  1. TEST – Trading Partners should submit and receive their test files under this root folder
  2. PROD – Trading Partners should submit and receive their production files under this root folder

Following folder will be available under TEST/PROD folder within SFTP root of the Trading Partner:

  • ‘HIPAA_Inbound’ – This folder should be used to drop the Inbound files that needs to be submitted to HCA
  • ‘HIPAA_Ack’. Trading partner should look for acknowledgements to the files submitted in this folder. TA1, 999 and custom error report will be available for all the files submitted by the Trading Partner
  • ‘HIPAA_Outbound’ – X12 outbound transactions generated by HCA will be available in this folder
  • ‘HIPAA_Error’ – Any inbound file that is not HIPAA compliant or is not recognized by ProviderOne will be moved to this folder
  • ‘HIPAA Working’ – There is no functional use for this folder at this time.

File Naming Convention

The HIPAA Subsystem Package is responsible for assisting ProviderOne activities related to Electronic Transfer and processing of Health Care and Health Encounter Data, with a few exceptions or limitations. HIPAA files are named: For Inbound transactions: HIPAA….

Example of file name: HIPAA.101721500.122620072100_P_1.dat

  • <TPId> is the Trading Partner Id
  • <datetimestamp>is the Date timestamp
  • <originalfilename> is the original file name which is submitted by the trading partner
  • All HIPAA submitted files MUST BE .dat files or they will not be processed.

HIPAA standards are specified for each mandated transaction and modified by authorized Addenda. An overview of requirements specific to the transaction can be found in the 837 Implementation Guide. HCA limits the size of the transaction (ST-SE envelope) to a maximum of 5,000 CLM segments. HCA limits a file size to 50 MB while uploading HIPAA files through the ProviderOne web portal and 100 MB through FTP.

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