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 →

Inbound Encounter Data File

Inbound Encounter Data File (IEHP Encounter Procedures) Inbound Encounter Data File must be submitted using SFTP. The files must be placed in the Encounter Folder within your Provider folder on the SFTP server. Inbound Encounter Data File Examples are given below. The naming convention for encounter data submissions consist of the following: A. All file names start with Read More →

Encounter data files

Encounter Data File Due Date Schedule Encounter data file must be submitted to IEHP using SFTP. The files must be placed in the Encounter Folder within your Provider folder on the SFTP server. IEHP places all response reports on the SFTP server in the RESPONSE_PROD folder in the Provider’s folder, (Example: /01s/5010/Encounters/RESPONSE_PROD/). The files are placed in the Read More →

Encounter Data Processing

Encounter Data Processing Procedures (IEHP and Providers) Encounter Data processing and reporting is a shared obligation of IEHP and Providers. CMS/DHCS has mandated encounter data report formats and reporting timelines with which IEHP is required to comply. IEHP, in turn, contractually requires capitated Providers to provide encounter data based on IEHP’s regulatory obligations. IEHP has streamlined reporting requirements, Read More →