EDI Billing File Transfer Reference

DRAFT FOR INTERNAL REFERENCE

Indiana

Billing Manager sends files to the Indiana File Exchange site, which then sends the information on to the State Medicaid claim site.

When a user clicks Create Invoices for a Bill, the system creates the invoices and then sends them to the file exchange site. This file is an 837 file. The EDI 837 transaction set is the format established to meet HIPAA requirements for the electronic submission of healthcare claim information.

The file exchange site creates a 999 file which is an acknowledgement file to show the file has been received. This file is sent back to Billing Manager and processed to show an acknowledgement.

Once payment is made, an 835 file is created by the exchange site and sent back to Billing Manager. The Electronic Remittance Advice (ERA), or 835, is the electronic transaction that provides claim payment information. This electronic payment is then processed by the user. See ************** for more detailed information.

What to do when EDI is not working

When EDI is not working, the user will need to manually upload and download files from the exchange site.

To upload the 837 Claim file:

1. Billing Manager creates a Batch File, which is the 837 file. Clicking on the link for the batch file will download the file to the user’s computer.

2. Go to the Indiana file exchange site and use the upload wizard to upload the file(s).

3. The files will now be processed and sent to the State.

To download 999 Acknowledgement file:

1. Go to the file exchange site and find the acknowledgement files (999s).

2. Download the files. Upload them to Billing Manager (See article ******)

Processing 835 is also in another article.

Where are the files located on the Server

On the server there is a folder under Program Data folder. This folder is sometimes hidden. If so, enter Program Data in the C: bar at the top of the folder window.

The folders are set up in this format shown below. Each year folder holds month folders where the files are stored.

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