Authorization EDI Data Exchange

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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 →

Encounter Identification by DHCS

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Encounter Identification

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 →