File Transmission (Claims File Exchange Via SFTP Server)

File Transmission

File Transmission by IEHP is released via a secure SFTP server for all claims file exchanges. Each direct submitter is assigned an account and a home directory on the SFTP. Within this home directory are several subfolders, each of which serves a specific purpose: – [Home Directory] – 5010 –

  • inbound – production claims file submitted to IEHP
  • outbound – production response files from IEHP
  • editest
    • inbound – test claims file submitted to IEHP
    • outbound – test response files from IEHP

For example, submitter ‘098’ would have a home directory on the SFTP of ‘098’. 837 claim files would be placed in the ‘/098/5010/inbound/’ subfolder. Response files would then be returned in the ‘/098/5010/outbound/’ subfolder.

The SFTP server will be available twenty-four (24) hours a day, seven (7) days a week for posting and picking up files. Please note that claim processing only takes place during regular business hours.

Hospital Claims

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

  1. All file names start with the Provider’s 3 digit Submitter ID number.
  2. The 4th character is ‘I’ for institutional hospital claims.
  3. The 5th through 10th characters for the date the file was created, MMDDYY.
  4. The 11th character is file sequence identifier sent on the same day, A-Z. (If needed, the 12th character may be used, AA-ZZ).
  5. The extension must be .837.PGP to identify all EDI Claims file submitted by the Provider.

If, during audit analysis of submissions, the rate is determined to be higher than 5.0%, IEHP may request a return to the testing phase to identify issues and resolve them before continuing to submit electronic claims. Folder paths for production file posting, on the SFTP, will be different than the folder
paths used for testing. Production processing schedules operate on business week schedules, with claims files on the SFTP processed at regular intervals through the course of the day.

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