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 Provider Healthcare Portal should view the Portal FAQs at the Indiana CoreMMIS web page.

General Questions

Q. How do I obtain a trading partner ID?

A. EDI Vendors: To obtain a trading partner identification (ID) for testing, follow the directions on the Software Testing Procedures page on this website.

A. Providers: View the Trading Partner Registration Procedure page on this website for step-by-step instructions for becoming a trading partner with the IHCP.

Q. How long does it take to receive my login information?

A. EDI Vendors: After receipt of the IHCP Trading Partner Profile, test IDs are assigned and sent within five business days.

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

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

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

Transaction Data Questions

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

A. 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 on this website for more information.

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

A. In the 837P transaction, the referring provider is located in loop 2310A within segment REF02. This segment contains the nine-digit provider number of the primary medical provider (PMP) or the IHCP provider number of the case manager for Waiver claims. See the IHCP Companion Guides page on this website for more information.

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

A. 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.