The Health Insurance Portability and Accountability Act (HIPAA) requires that all healthcare organizations that exchange HIPAA transaction data electronically with the Indiana Health Coverage Programs (IHCP) establish an electronic data interchange (EDI) relationship. Entities with this EDI relationship are referred to as trading partners. The IHCP has prepared the following information to assist entities with becoming IHCP trading partners.
Providers That ARE NOT Required to Become IHCP Trading Partners
Billing providers that exchange data with the IHCP exclusively using the following methods do NOT need to become IHCP trading partners:
- Clearinghouse that has been approved by the IHCP
- Billing service that has been approved by the IHCP
- Provider Healthcare Portal
- Interactive Voice Response (IVR) system
Providers must use a software vendor, billing service or clearinghouse that has been approved by the IHCP to exchange data. Providers must review the IHCP-approved software developers to ensure that their vendor has been approved. There is no affiliation between the IHCP and any of the companies on the approved vendor list. It is the responsibility of the provider to select a vendor based on specific business needs.
Providers That ARE Required to Become IHCP Trading Partners
Providers developing their own software must follow the Software Testing Procedures before becoming a trading partner.
Billing providers that directly exchange data electronically with the IHCP must become IHCP trading partners by doing the following:
1. Complete a Trading Partner Profile
The IHCP requires billing providers exchanging data directly with the IHCP to complete and submit the IHCP Trading Partner Profile to initiate the process for becoming a trading partner. The IHCP Trading Partner Profile is the tool providers must use to notify the IHCP about the types of transactions they will exchange and the software they will use.
The IHCP Trading Partner Profile is also used to inform the IHCP of any changes to trading partners' vendor software, billing service or clearinghouse selection.
2. Complete a Trading Partner Agreement
The IHCP Trading Partner Agreement is a contract between parties that have chosen to become electronic business partners. The IHCP Trading Partner Agreement stipulates the general terms and conditions under which the partners agree to exchange information electronically. If billing providers send multiple transaction types electronically, only one signed IHCP Trading Partner Agreement is required. Billing providers must print and complete a copy of the IHCP Trading Partner Agreement. It must be signed and emailed to INXIXTradingPartner@gainwelltechnologies.com or faxed to 317-488-5185.
Upon receiving the IHCP Trading Partner Profile form and the signed IHCP Trading Partner Agreement, the billing provider will be evaluated for exchanging production data. The trading partner will receive written notification of approval within five business days.