Indiana Health Coverage Programs

Frequently Asked Questions

The questions listed below pertain to providers and EDI vendors who send and receive data electronically using a software developer, clearinghouse or billing service. Providers using Web interChange should view the FAQs on the Web interChange site.

General Questions:

How do I obtain a trading partner Id?
How long does it take to receive my login information?
How do I get set up for the 835 transaction? I am already setup for 837.
If I submit my claims via a clearinghouse or software vendor, how long does it take to see them on Claim Inquiry on Web interChange?

Communication Questions:

I am receiving a Time Out message when sending a file. What am I doing wrong?
Is it possible to submit claims and retrieve reports in the same dial-up session?

Transaction Data Questions:

What segment and loop are the group provider number and rendering provider number located on within the 837P?
What segment and loop are the referring provider and certification code located on within the 837P?
Why are discrepancies noted when comparing the paper RA with the 835 transactions?

How do I obtain a trading partner Id?

EDI Vendors: To obtain a trading partner Id for testing, follow the directions in Software Testing Procedures.

Provider: View Provider EDI Implementation Procedures for step-by-step instructions for becoming a trading partner with the IHCP.

How long does it take to receive my login information?

EDI Vendors: After the IHCP Trading Partner Profile is received, then the EDS EDI Department will assign and send out test Ids within five business days.

Provider: Once your software vendor is approved for production, the EDS EDI Department will assign and send out production Ids within five business days.

How do I get set up for the 835 transaction? I am already setup for 837.

To get set up for the 835 transaction, submit the trading partner profile and indicate 835 and your software company or clearinghouse name. Your provider number will be linked to the appropriate trading partner Id to receive the 835. Allow five business days for this set up.

If I submit my claims via a clearinghouse or software vendor, how long does it take to see them on Claim Inquiry within Web interChange?

All claims submitted electronically, either via a clearinghouse, vendor or Web interChange is viewable in claims inquiry after two hours if the claim is submitted between 8:00 AM and 5:00 PM. Claims submitted after 5:00 PM are viewable after 8:00 AM the next business day.

I am receiving a Time Out message when sending a file. What am I doing wrong?

View the Batch Submission section of the Communication Options Companion Guide for the login script required for sending a batch file. After receiving the "Ready to Receive File" message, you must initiate the sending of the file. An example of this could be - choosing the file and selecting Send. The exact procedure depends on the type of communication software being used.

Is it possible to submit claims and retrieve reports in the same dial-up session?

No, separate dial-up sessions are necessary to submit claims and retrieve reports.

What segment and loop are the group provider number and rendering provider number located on within the 837P?

In the 837P transaction, the billing provider number is located in loop 2010A within segment REF02. The rendering provider number is located in loop 2310B within segment REF02. View the IHCP Companion Guides for more information.

What segment and loop are the referring provider and certification code located on within the 837P?

In the 837P transaction, the referring provider is located in loop 2310A within segment REF02. This segment contains either the 9-digit provider number of the PMP or the IHCP provider number of the case manager for Waiver claims. The 2-digit PMP certification code is located in loop 2300 within segment REF02. View the IHCP Companion Guides for more information.

Why are discrepancies noted when comparing the paper RA with the 835 transactions?

For clarification, the paper RA reports only dollar amounts without balancing concerns. This dollar amount reflects prior payment information including spend-down, third party liability (TPL), and Medicare payments; or Medicare co-insurance or deductible as submitted with the original claim. For a technical example of the IHCP 835 transaction adjustment information related to the balancing methodology identified in the 4050 draft version of the 835 guide, please review IHCP Providers Receiving the 835 Electronic Remittance Advice Transaction for more information.

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