EDI Solutions - Trading Partner Profile

The Indiana Health Coverage Programs (IHCP) requires specific information for electronic data submission. Please provide the requested information to assist with establishing an electronic data interchange (EDI) trading partner relationship with the IHCP.
Data will be submitted electronically by one of the following (check the appropriate box):
Trading Partner Type
Provider   Clearinghouse / Vendor   Managed Care Entity
 
Trading Partner Contact Information
Company name 
Business contact name and title
Address
City
State    Zip
Telephone number - -
Fax number - -
Email Address
 
Technical Contact Information
Technical contact name
Address
City
State    Zip
Telephone number - -
Fax number - -
Email Address
 
If you have questions or need additional information, please email trading partner support at INXIXTradingPartner@gainwelltechnologies.com or call 800-457-4584, Option 3, then Option 1. 
  New Trading Partner Setup
  Existing Trading Partner Update
Indicate Reason for Update / Comments
 
 
Data Submission Criteria
Please provide information about the transaction sets you plan to exchange with the IHCP. All transaction sets are currently in ASC X12N standard format, version 5010. Click the Companion Guides button and then click the appropriate transaction from the list for additional information and IHCP-specific technical specifications.
 
IHCP Provider Number
Current Sender ID
 
Please indicate the transaction sets and submission information you will send or receive.
Note: Your software vendor or clearinghouse/billing service must be approved before you can become a trading partner.
 
Inbound Transactions
Transaction Sets to the IHCP
  270 - Batch Eligibility Request
  Software Vendor      Company Name
  Clearinghouse/Billing Service      Company Name
  270 - Interactive Eligibility Request
  Software Vendor      Company Name
  276 - Batch Claim Status Request
  Software Vendor      Company Name
  Clearinghouse/Billing Service      Company Name
  276 - Interactive Claim Status Request
  Software Vendor      Company Name
  278 - Referral Certification and Authorization Request (Prior Authorization)
  Software Vendor      Company Name
  Clearinghouse/Billing Service      Company Name
837D - Batch Health Care Claim Dental
  Software Vendor      Company Name
  Clearinghouse/Billing Service      Company Name
  837I - Batch Health Care Claim Institutional
  Software Vendor      Company Name
  Clearinghouse/Billing Service      Company Name
  837P - Batch Health Care Claim Professional
  Software Vendor      Company Name
  Clearinghouse/Billing Service      Company Name
Outbound Transactions
Transaction Sets from the IHCP
  271 - Batch Eligibility Response
  Software Vendor      Company Name
  Clearinghouse/Billing Service      Company Name
  271 - Interactive Eligibility Response
  Software Vendor      Company Name
  277 - Batch Claim Status Response
  Software Vendor      Company Name
  Clearinghouse/Billing Service      Company Name
  277 - Interactive Claim Status Response
  Software Vendor      Company Name
  278 - Referral Certification and Authorization Response (Prior Authorization)
  Software Vendor      Company Name
  Clearinghouse/Billing Service      Company Name
  835 - Remittance Advice
  Software Vendor      Company Name
  Clearinghouse/Billing Service      Company Name
 

If you have completed the form please click Submit.