837 Health Care Claim

837 Health Care Claim Technical Procedures And Infrastructure (IEHP Provider Network) 837 Health Care Claim: Professional Transaction must be transmitted by business partners to IEHP by connecting to the IEHP Network. They go from the Internet through a Virtual Private Network (VPN) tunnel to the IEHP Secure File Transfer Protocol (SFTP) Server. In standard software-to-hardware VPN connections, VPN client Read More →

EDI Files

EDI Files Timeframe And Schedules For IEHP EDI Providers EDI Files processing schedules and timelines must be adhered to for IEHP COB plans. These schedules include: Eligibility Data File Transmission Schedule, Encounter Data File Due Date Schedule, Capitation Data File Transmission Schedule. Eligibility data files are placed on the Secure File Transfer Protocol (SFTP) server. A full monthly file is Read More →

File Transmission

File Transmission (Claims File Exchange Via SFTP Server) 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: sftp.iehp.org – [Home Directory] – 5010 – Read More →

CAQH CORE 259

CAQH CORE 259: AAA Error Code Reporting Rule CAQH CORE 259: Operating Rule states that the receiver of the X12 271 response, i.e., the system that originated the X12 270 inquiry, is required to detect all combinations of error conditions from the AAA segments in the X12 271 responses, and to display to the receiving Read More →

CAQH CORE 258

CAQH CORE 258: Normalizing Patient Last Name Rule CAQH CORE 258 Operating Rule requires the removal of both the apostrophe and the hyphen in the O’Donnell-Griswold example cited. The normalized name would be ODONNELLGRISWOLD. CAQH CORE 258: Last Name Normalization Rule Version 2.1.0 does not address this specific scenario. Since the characters “De” are not included in Read More →

X12 276/277 Transactions

X12 276/277 Transactions In CAQH CORE 250: Claim Status Rule X12 276/277 Transactions can be tracked throughout a system/application to demonstrate conformance with the response time requirements specified in the CAQH CORE 250 Rule. CAQH CORE 250: Claim Status Rule requires HIPAA covered entities to capture, log, audit, match, and report the date, time, and control Read More →

CAQH CORE HTTP/S

CAQH CORE HTTP/S Vendor Parties Guidelines CAQH CORE HTTP/S vendor rules do not require that an entity (provider or health plan) implement the technology directly into their own data center. The Phase I CAQH CORE Rules implicitly acknowledge that both providers and health plans will use technology solutions provided by vendors to accomplish all that must Read More →

CAQH CORE Batch Processing

CAQH CORE Batch Processing Vendor Requirements CAQH CORE Batch Processing: Why not FTP or sFTP for batch transactions instead of HTTP/S?HTTP/S is robust and has a proven track record with batch transactions. The benefits of a single communication standard were a compelling reason to mandate its availability. Information sources that allow FTP and/or sFTP for Read More →

EDI HTTP

EDI HTTP Guidelines For CAQH CORE 250: Claim Status Infrastructure Rule EDI HTTP guidelines refer to parties contracting with Medicare and CAQH CORE-authorized testing vendors. One of the typical questions from vendors – “Is there a required format in Phase I CAQH CORE Connectivity for the authorization, date/time, and payload ID to be sent in the Read More →

healthcare-technology

EDI 837 Common Ground Healthcare Cooperative Highlights EDI 837 Common Ground Healthcare Cooperative transaction requires efficient and accurate electronic transaction processing. To promote this EDI partners should note: Each user is assigned a 6-digit EDI Direct Trading Partner ID. Logon User Name is 8 characters. Logon User ID (password) is 9 characters. All dates are in the CCYYMMDD format. Read More →