Authorization EDI Data Submission Requirements (IEHP Providers) Authorization EDI Data policy applies to IPAs and other Entities that have been delegated medical management where IEHP retains financial risk or administrative processing for those services. IEHP contractually requires Independent Provider Associations (IPAs) to submit all authorization data to IEHP at a minimum frequency of once per business day and … Read More →
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 … Read More →
Encounter Identification (IEHP Provider EDI Requirements) To aid in Encounter Identification, plans must use the HCP number of the plan that the beneficiary was enrolled in at the time of the encounter as the first three characters of CLM01. In accordance with X12 837 Professional data specification rules, unless the encounter is a void or replacement, CLM01 must … Read More →
IEHP EDI Network Testing Basics And DHCS Duplicate Logic IEHP EDI Network Providers will be required to submit test files to ensure the submitter’s systems are properly configured for data submission. Before exchanging production transactions, each plan must complete testing to become certified. This process allows IEHP EDI Network to confirm that the DHCS operational guidance has been properly programmed … Read More →