Authorization EDI Data

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 EDI Network

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 →

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 →

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 →

IEHP EDI Outbound Respons

IEHP EDI Outbound Response Files (Provider Connection) IEHP EDI Outbound Response Files (reports) are placed on the SFTP server in the Response_Prod folder in the Provider’s folder. An example of the file naming convention for the report describing the reasons the interchange control structure was not valid is 01s0318h101_40605_201604122150.TA1. A. 01s0318h101 identifies the original file name 1. (Reference the Read More →