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.

You will need Adobe Acrobat Reader 4 or later to view the PDF files. You can download a free copy by clicking here.

  2018 EDI Manual

Table of Contents

1 - General Information

2 - Getting Started - SFTP

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 CMC Encounter Companion Guide 

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

10 - IEHP 5010 837P Professional CMC 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 Claim Companion Guide

14 - Authorization Data Exchange

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.