IEHP 5010 837I Institutional Claim

IEHP 5010 837I Institutional Claim Transaction Basics

IEHP 5010 837I Institutional Claim requirements are given below for providers submitting health care claims to IEHP via EDI Network and for those who are intended to start EDI exchange with IEHP.

Clearinghouse/IEHP Direct Providers Submitting Claim Data

Clearinghouses are largely used as an intermediary for fee-for-service Providers, hospitals, and other Providers submitting claims to IEHP electronically. Capitated IEHP Direct Providers may also elect to submit data through the claim system directly or through a clearinghouse. The clearinghouses must follow the instructions outlined in IEHP requirements and will pass it on to their Providers as appropriate to ensure compliance. The same situations and requirements laid out in the Implementation Guides published by Washington Publishing Company will be expected to be followed by Clearinghouse and IEHP Direct submitters alike.

Fee-for-Service Hospital Submitting Claim Data

Fee-for-Service Hospitals may elect to submit 837 Institutional files without using a clearinghouse. All the same guidelines and requirements apply. The same situations and requirements laid out in the Implementation Guides published by Washington Publishing Company will be expected to be followed by Hospital submitters.

Providers must use software compatible with the Open PGP standard to encrypt and decrypt data files exchanged with IEHP (including 999 or 277CA or log files). To decrypt the files, Providers choose “Decrypt”, select the transmitted files, and then enter their Pass Phrase.

IEHP supports the instructions in the Technical Report Type 3 (TR3) implementation guides (IG) available for purchase from Washington Publishing Company regarding Billing Provider Address and 9-digit zip codes. Therefore, the Billing Provider Address (2010AA, N3) is required and must be a physical address. PO Box and lock box addresses cannot be reported as a Billing Provider Address, but can continue to be reported in the pay-to address (2010AB, N3). The 5010 requires that all used N403 segments must contain a full 9-digit zip code. The best way to determine the 4-digit extension to your standard zip code is by contacting the US postal Service. These instructions apply to all claims for all Health Care Providers.

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