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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  2017 EDI Manual

Table of Contents

I - General Information

II - Getting Started - Secure File Transfer Protocol (SFTP) Procedures 

III - Eligibility Processing Procedures

IV - Encounter Data Processing Procedures

V - Capitation Processing Procedures

VI - Claims EDI Processing Procedures

VII - Timeframe and Schedules

VIII - IEHP 5010 837I Institutional CMC Encounter Companion Guide 

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

X - IEHP 5010 837P Professional CMC Encounter Companion Guide 

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

XII - 5010 Standard Claims Companion Guide 

XIII - 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.