EDI Manual

The 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 HIPAA compliant which is required under the IEHP Agreement.

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  2019 EDI Manual

Table of Contents

1 - General Information

2 - Getting Started

3 - Eligibility Processing Procedures

4 - Encounter Data Processing Procedures

5 - Capitation Processing Procedures

6 - Claims EDI Processing Procedures

7 - Timeframe and Schedules

8 - IEHP 5010 837I Institutional IEHP DualChoice Encounter Companion Guide

9 - IEHP 5010 837I Institutional Medi-Cal Encounter Companion Guide

10 - IEHP 5010 837P Professional IEHP DualChoice Encounter Companion Guide

11 - IEHP 5010 837P Professional Medi-Cal Encounter Companion Guide

12 - IEHP 5010 837I Institutional  Claims Companion Guide

13 - IEHP 5010 837P Professional Claims Companion Guide

14 - Authorization Data Exchange

15 - IEHP 5010 834 Eligibility Companion Guide

For comments, questions about this manual or technical support, contact the IEHP IT Help Desk at (909) 890-2025 or by email at: HELPDESK@iehp.org.