EDI Vendors: To obtain a trading partner Id for testing, follow the directions in Software Testing Procedures. Provider: View Trading Partner Registration Process for step-by-step instructions for becoming a trading partner with the IHCP.
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, and a signed Trading Partner Agreement is received, the EDS EDI Department will assign and send out production Ids within five business days.
To get set up for the 835 transaction, submit the EDI Outbound Transactions Request form Your provider number will be linked to the appropriate trading partner Id to receive the 835. Allow five business days for this set up.
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.
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.
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.
For clarification, the web interChange 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 Electronic 835 / Web interChange RA Comparison for more information.
