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 →

blog_7stepstoachieve95cleanclaimssubmissionratio

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 Read More →

EDI Enrollment

EDI Enrollment With Inland Empire Health Plan (IEHP) EDI Enrollment will be a smooth process, if a completed enrollment form was submitted to the EDI department at IEHP, providing all information need to get started. This includes details about the enrollee, the primary and technical contacts, and the types of claims EDI transactions being requested, 837I/837P/835. If the enrollee will be Read More →

bigstockphoto_Irs_Electronic_Filing_2312361

Claims EDI Processing (IEHP Providers EDI) Claims EDI Processing Submission helps to speed processing and ensure accuracy and security. While direct submission of claims is allowed, this option is more practical for large Provider groups and facilities. Many Providers and billers may find that a more realistic method is to utilize a claims clearinghouse. Claims data contains private healthcare Read More →

EDI COB

EDI COB Center For Celerian Group Companies Customers, Beneficiaries And Providers EDI COB Center Assistance is given for CGS (Celerian Group Companies) contractors regarding EDI Coordination of Benefits issues. EDI COB Center Assistance (Benefits Coordination & Recovery Center) is provided to: All Customers Answers to general questions regarding Medicare Secondary Payer (MSP). Requests for duplicate questionnaires. Beneficiaries Read More →

EDI Coordination of Benefits

EDI Coordination of Benefits Basics For Celerian Group Company Medicare Contractors EDI Coordination of Benefits program purposes are to identify the health benefits available to a Medicare beneficiary and to coordinate the payment process to prevent mistaken payment of Medicare benefits. The BCRC (Benefits Coordination & Recovery Center) consolidates the activities that support the collection, management, and reporting Read More →

ASC X12 Implementation

ASC X12 Implementation Acknowledgement (999) (CAQH CORE Certification) ASC X12 Implementation Acknowledgement (999) must be always returned by CORE-certified organizations. The organization must successfully complete all of the required certification test scripts required by the Phase II CAQH CORE Certification Test Suite to become CORE-certified. The ASC X12 Implementation Acknowledgement (999) can be used only to acknowledge Read More →

X12 Interchange Acknowledgement (250: Claim Status Infrastructure Rule) X12 Interchange Acknowledgement must be returned for real time X12 276 claim status inquiries if the functional group is rejected, or the X12 277 response, to be conformant with this rule. CAQH CORE Rules do not address usage of the X12 Interchange Acknowledgement TA1.  To send real time acknowledgments Read More →

HIPAA CAQH CORE Batch Processing (250: Claim Status Infrastructure Rule) HIPAA CAQH CORE recognizes that every organization has its own record-retention policies and, therefore, does not mandate a strict requirement for retention of response files. However, CAQH CORE recommends that a copy of responses be kept available for a minimum of six months after they Read More →

HIPAA CAQH CORE

CAQH CORE HTTP/S (250: Claim Status Infrastructure Rule) Connectivity CAQH CORE HTTP/S is secure and reliable enough to protect the delivery of healthcare information over the Internet. In Phase I development discussions, CAQH CORE solicited input on this topic from its Technical Work Group members and experts within healthcare and other industries, such as financial services. Based on Read More →