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Common Compliance Errors Detected by the IHCP Translator |
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Transactions can be rejected for compliance errors in the ISA envelope. The ISA must be
received exactly as expected. The
IHCP Companion Guides contain the valid ISA envelope values.
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Common rejections due to invalid data in ISA:
- Duplicate file received
- ISA06 and GS02 contain test ID, when data sent is production data
- ISA06 and GS02 contain pre-X12 production ID
- ISA06 and GS02 contain login ID instead of trading partner ID
- ISA08 and GS03 do not contain IHCP
- ISA15 contains T instead of P for Production
- Trading partner ID received in ISA06 does not match the trading partner ID
linked to the login ID used to send file
- File is not X12 – sending proprietary format or non-IHCP data
Files rejected due to these reasons will not create a 997 or Biller Summary
Report and will not be processed.
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Common rejections due to missing or invalid data with the transaction:
-
837 Billing of Crossover Claims Directly
contains instructions for the billing of claims to the IHCP for dually eligible
members (Medicare and Medicaid) that are initiated by the provider.
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837 Billing of TPL Claims
contains instructions for the billing of claims to the IHCP with Third Party
Liability (TPL) coverage.
- CLM02 does not equal the total of SV02 segment – results from the total claim charge
does not equal the total of all the details.
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