Encounter data file

Encounter Data File Due Date Schedule

Encounter data file must be submitted to IEHP using SFTP. The files must be placed in the Encounter Folder within your Provider folder on the SFTP server.

IEHP places all response reports on the SFTP server in the RESPONSE_PROD folder in the Provider’s folder, (Example: /01s/5010/Encounters/RESPONSE_PROD/). The files are placed in the Provider’s response folder within three (3) working days from their receipt date, as long as the files conform to IEHP naming conventions and procedures. IEHP notifies the Provider via e-mail upon receipt of a file. Once the files have been processed, an additional e-mail is sent to notify the Provider that reports are ready to be picked up. It is the Provider’s responsibility to check the SFTP server for any error reports within three (3) working days of file submission. A report is transmitted for each file submitted. If a report is not received within three (3) working days of file submission, the Provider should notify the Electronic Data Interchange department.

Encounter Data Questions and Answers

How is validity determined? – Validity is determined by calculating the number of unique Claim Reference Numbers (CRNs) submitted within the file less the number of non-fatal errors. The number of
valid CRNs is divided by the result. The accumulation of all encounter data records submitted with the same file name must be at least 95% valid in order to meet IEHP validity standards.

How is adequacy determined? – Adequacy is determined by grouping all the valid data received by month of service and then performing a count on place of service and/or procedure codes to determine if the encounter was an inpatient, physician visit, outpatient or emergency room service.

Can we use the same Patient Control Number (CLM01) as long as the files are named differently? – No. The Patient Control Numbers (CLM01) must always be a unique number assigned to that encounter.

How do we correct an encounter that has been deemed invalid by IEHP? – When an 837 encounter has been deemed invalid by IEHP make the necessary correction to the encounter In Loop 2300 (Claim Information), CLM segment must have one of these qualifier codes: CLM05-3 = 1 Original claim submission.

How do we correct an encounter once IEHP has accepted the 837 file containing that record? – When an 837 encounter file has been accepted by IEHP please use the following guidelines for submitting a Corrected, Replacement or Void\Delete encounter record.

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