EDI Files Timeframe And Schedules For IEHP EDI Providers

EDI Files processing schedules and timelines must be adhered to for IEHP COB plans. These schedules include: Eligibility Data File Transmission Schedule, Encounter Data File Due Date Schedule, Capitation Data File Transmission Schedule.

EDI FilesEligibility data files are placed on the Secure File Transfer Protocol (SFTP) server. A full monthly file is provided by the 1st of each month. Weekly files, containing updated information are provided three times a month. Providers are required to pick up their eligibility information from the SFTP server within three (3) days of transmission by IEHP.

IEHP requires the submission of a daily manifest report containing a list of all 837 I and 837P Claim files.

IPAs are required to submit eligibility lists to their contracted PCPs by the 5th and 15th of each month for the current months’ enrollment. Encounter data files are due the first of each month. Providers are required to meet Adequacy and Validity standards by the end of the month in which they are due. Capitation Summary and Detail files are placed on the SFTP server by the 1st of each month for the prior month’s capitation. Capitation is based on the Provider enrollment as of the 15th day of each month.

EDI Files Naming Conventions

The naming convention for Manifest EDI Claim submissions consists of the following:

  1. All file names start with the Provider’s three (3) digit Submitter ID number.
  2.  The 4th, 5th character is ‘MF’ for Manifest report.
  3. The 6th through 11th characters for the date the Manifest file was created, MMDDYY.
  4. The extension must be .MF.PGP to identify the Manifest submitted by the Clearinghouse/Trading Partner.

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