FAQs - EDI

The following frequently asked questions (FAQs) pertain to Indiana Health Coverage Programs (IHCP) providers and electronic data interchange (EDI) vendors that send and receive data electronically using a software developer, clearinghouse or billing service. Providers using the IHCP Provider Healthcare Portal (Portal) should view the Portal FAQs.

• How do I obtain a trading partner ID?

  EDI Vendors: To obtain a trading partner ID for testing, follow the directions on the Software Testing Procedures page.

  Providers: View the Trading Partner Registration Procedure page 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 receipt of the Vendor IHCP Trading Partner Profile, test IDs are assigned and sent within five business days.

  Providers: After your software vendor is approved for production and a Provider IHCP Trading Partner Profile and signed Trading Partner Agreement are received, production IDs are assigned and sent within five business days.

• On what segment and loop are the group provider number and rendering provider number located in the 837P?

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

• On what segment and loop is the referring provider located in the 837P?

  In the 837P transaction, the referring provider is located in loop 2310A within segment REF02. This segment contains the 10-digit National Provider Identifier (NPI) of the referring healthcare provider, or the IHCP Provider ID if the referral is from an atypical provider. See the IHCP Companion Guides page for more information.

• I submitted a claim file that was accepted; however, I am not finding the claim using Claim Inquiry on the Portal.

  Check to see if you received a 277U Unsolicited Claim Status Response file on the date the claim file was submitted. The 277U reports claims that denied due to errors with the billing provider information. One of the common denials is due to the crosswalk from the National Provider Identifier (NPI) to the IHCP Provider ID for the billing provider. If a one-to-one match cannot be established, the claim denies and is posted to the 277U transaction but is not viewable on the Portal. See the 277U IHCP Companion Guide for additional information.

• How does a provider get set up to receive the 835 transaction?

  Providers must initiate the 835 electronic Remittance Advice (ERA) enrollment by making updates to their provider profile on the Portal. Use the Provider Maintenance page of the Portal (ERA Changes) to enroll, change or delete an 835 setup. The change is effective immediately.

• Why are there discrepancies when I compare the RA viewable on the Portal with the 835 transaction?

  For clarification, the Remittance Advice (RA) viewable on the Portal reports only dollar amounts without balancing concerns. These dollar amounts reflect prior payment information, including spend-down, third-party liability (TPL) and Medicare payments, or Medicare coinsurance or deductible, as submitted with the original claim.