San Francisco Health Plan EDI Testing Process Overview
San Francisco Health Plan EDI submitter setup must be completed before the submitter can send eligibility status transactions to the test San Francisco Health Plan EDI environment. San Francisco Health Plan notifies the provider after the successful completion of testing and prepares the provider for production status.
During the San Francisco Health Plan EDI testing process, San Francisco Health Plan examines submitted test transactions for required elements, and also ensures that the submitter gets a response during the testing mode. When the submitter is ready to send San Francisco Health Plan EDI ANSI 270/271 transactions to a production mailbox, they must notify San Francisco Health Plan Provider Relations. Provider Relations then moves the submitter to the production environment. The submitter’s mailbox name remains the same when moving from test to production. Changing passwords is optional upon submitter’s request to the Provider Relations Team.
San Francisco Health Plan EDI Real-time Process Flow
The user application submits an SOAP request and MIME request. Eligibility status system authenticates the user. If the user is successfully authorized, the following files will be issued within 20 seconds:
- TA1 (if problem with the ISA/IEA segments exist)
- 999 Reject (if problem occurs within the subsequent loops and segments)
- 271 Eligibility Response
San Francisco Health Plan EDI Batch Process Flow
The user application submits an SOAP request and MIME request. Eligibility status system authenticates the user. If the user is successfully authorized, one of the following will be generated back to the user:
- TA1 available within one hour, if there is a problem with the ISA or IEA segments
- 999 Reject available within one hour, if there is a problem with the segments occurring between the ISA and IEA.
- 999 Acceptance response will be available within one hour.
- The 271 transaction(s) will be available the following day (no later than 7:00a.m)
Response Times A response (TA1, 999 reject or 271) to real-time inquiries will be provided within 20 seconds. A response to the batch inquiry will be provided by 7 a.m. (ET) the following day. Batch requests submitted after 9 p.m. (ET) will be available by 7 a.m. (ET) two days following submission.
San Francisco Health Plan EDI Communication Protocol Notes
The following is a list of technical standards and versions for the SOAP envelope and Eligibility status payload:
- HTTP Version 1.1
- CSOAP Version 1.2
- SSL Version 3
- Health Care Eligibility Status Request and Response Version 005010X279A1
- CAQH SOAP (San Francisco Health Plan supports the use of HTTP SOAP + WSDL envelope standards)
The following is a list of technical standards and versions for the HTTP MIME multipart envelope and eligibility status payload:
- HTTP Version 1.1.
- SSL Version 3.0
- MIME Version 1.0
- Health Care Eligibility Status Request and Response Version 005010X279A1 • CAQH MIME (San Francisco Health Plan supports the use of HTTP MIME Multipart existing envelope standards and has implemented the HTTP MIME Multipart envelope standards as identified in CAQH CORE Phase I/II Connectivity standards).