This page contains Indiana Health Coverage Programs (IHCP) companion guides for Health Insurance Portability and Accountability Act (HIPAA) version 5010 electronic transactions. The guides contain structure and specifications for transactions exchanged directly with Gainwell Technologies (fiscal agent for the IHCP). Providers and vendors developing software for electronic data interchange (EDI) may need to view multiple guides.
The IHCP companion guides are updated as needed. See the Change Summary section within each guide for a history of updates. When a system modification is forthcoming, significant changes are described in advance in the Upcoming Changes for IHCP Companion Guides section of this page.
The IHCP companion guides are intended only to supplement the adopted national electronic data interchange transaction set implementation guides. These implementation guides, published by the Washington Publishing Company, are available through the X12 website at X12.org/products. The IHCP companion guides are never intended to modify, contradict or reinterpret the rules established by the implementation guides.
IHCP Companion Guides
|IHCP Connectivity Guide V3.4||August 2019|
|TA1 and 999 Acknowledgements V1.5||March 2022|
|270/271 Health Care Eligibility Benefit Inquiry and Response Transactions V3.7||December 2021|
|276/277 Health Care Claim Status Request and Response Transactions V3.3||July 2019|
|277U Health Care Payer Unsolicited Claim Status Response V3.3||March 2022|
|820 MCE Capitation Payment Information Transaction V3.8||October 2021|
|834 MCE Benefit Enrollment and Maintenance Transaction V5.8||March 2023|
|835 Health Care Claim Payment/Advice Transaction V3.3||May 2022|
|837D Health Care Claim: Dental Transaction V4.0||March 2022|
|837I Health Care Claim: Institutional Transaction V3.8||March 2022|
|837P Health Care Claim: Professional Transaction V3.9||January 2023|
The IHCP companion guide for electronic prior authorization transactions, 278 Prior Authorization Request and Response, is available from the Key Links page of the Kepro website.
The IHCP companion guide for electronic pharmacy claim transactions, National Council for Prescription Drug Programs (NCPDP) D.0 Transaction Payer Sheet, is available from the Optum Rx Indiana Medicaid website.
Two IHCP companion guides for Dual Eligible Special Needs Plan (D-SNP) claim transactions – one for 837I and 837P claims, and one for pharmacy prescription drug events (PDEs) – are available on the Dual Eligible Special Needs Plans page on the IHCP partner website.
When system modifications are planned, advance notification is given to allow vendors time to make appropriate changes to their software and perform testing, if needed. The following documents describe upcoming changes to applicable IHCP companion guides. Please review these documents and make necessary modifications to your system before the implementation date.
|No upcoming changes at this time|