This manual documents the procedures, protocols and formats for electronic data exchange between IEHP and its contracted Providers related to Member eligibility, encounter data, bedday reporting, capitation reports and electronic claims submissions.

The following sections document the processing schedules, file formats, procedures and narrative information that is necessary for Providers to understand and conduct electronic data exchange that is HIPPA compliant which is required under the IEHP Agreement.

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 Table of Contents

 Section I   - General Information

 Section II  - Getting Started File Transfer Procedures

 Section III - Eligibility Processing Procedures

 Section IV  - Encounter Data Processing Procedures

 Section V   - Capitation Processing Procedures

 Section VI  - Claims EDI Processing Procedures

 Section VII - Timeframe and Schedules

 Section VIII- Provider I.D. Codes

Comments or questions about this manual, or procedures identified within, should be directed to an IEHP Data Specialist at (909) 890-2966.  For technical support, contact the IEHP IT Help Desk at (909) 890-2025 or by email at: HELPDESK@iehp.org.