SFTP Connection Testing

SFTP Connection Testing (IEHP EDI Partners)

SFTP Connection Testing may be started after the submitter ID and SFTP credentials have been created, and a new enrollee will work with the Service Delivery Team to test the connection to the SFTP server. Test files will be uploaded and downloaded to ensure no problems exist with the credentials before moving on to testing claims files.

Implementation Guide/Companion Guide Testing

During the IG/CG testing, submitters are required to submit fifty (50) 837I claims for 837P one hundred fifty (150) claims to the specific test subfolders on the SFTP to be evaluated for compliance with the X12 Implementation guide and the IEHP Companion Guide. Providers are also urged to utilize third-party testing services, prior to submitting to IEHP to ensure X12 standards are met.

The IT EDI Specialist uses several tools to analyze test files and validate against the IG and CG file format requirements, verifying that all loops and segments are included as required. Any issues found will be documented and reported back to the submitter for investigation, correction and submission of a new test file. This step may repeat several times, until all concerns have been address. After the IT EDI Specialist has indicated that test files are consistently showing no signs of structural errors over several iterations, the files will be advanced into the next phase of testing.

Clean Claim Data Validity

During this phase of testing, test files are sent through end-to-end system processing to ensure all data required, for the successful payment of a claim, is present and valid. Items under review consist of: valid diagnosis and procedure coding, correct dates of service, presence of the service location, billing and rendering Provider information, member identifiers, and member eligibility. The IT EDI Specialist will document and report any issues to the submitter and request additional test files as needed until tested files consistently pass at or below the acceptable rejection rate.

Rejection Rate and Auditing

The primary motivation to submit electronic claims is to ensure the secure, accurate, and timely processing of claims. Rejected claims can jeopardize the integrity of electronic claims processes by requiring manual intervention and resource expenditure. A standard rejection rate is used as an indicator of electronic claims utility.

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