About EDI

The Electronic Data Interchange (EDI) on the New Hampshire MMIS Health Enterprise Portal allows a trading partner to send X12 format files or receive files via the file retrieval process.

The X12 Submission Process

As a provider registered as a trading partner for Medicaid services, you can submit Electronic Data Interchange (EDI) transactions securely through the New Hampshire MMIS Health Enterprise Portal. The types of X12 files that you indicated that would be sent were identified on your enrollment application. No specified naming convention is required so you can set up your own standard naming convention, if needed.

The following types of X12 formats files (considered as inbound files) that NH MMIS can receive are:

• 270 Eligibility Inquiry
• 276 Claim Status Inquiry
• 278 Prior Authorization Request
• 837 Dental Claim
• 837 Institutional Claim
• 837 Professional Claim

NH MMIS validates that you are a registered trading partner and ensures that the file is in X12 format. Once your submission is complete, the file is renamed using the following naming conventions:

I<TPD>_<Source (Portal or GrabIT or Async or MFT)>_<Original File Name>_<Date>_<TimeStamp>.txt

Note: Your Original File Name is preserved and is part of the naming convention being used by NH MMIS and EDI.

After the X12 format files you sent are received and If you are an authorized provider, you will receive a verification message directly through the Provider Message Center.

File Retrieval Process

Trading partners can exchange files with NH MMIS using EDSG (External Data Sharing Gateway). Every trading partner has an EDSG Mailbox (which is a virtual storage space) that has been created during their enrollment process. The EDSG Mailbox can also be accessed using the secure portion of the New Hampshire MMIS Health Enterprise Portal to download the exchange files.

The trading partner uses the File Retrieval Mailbox page on New Hampshire MMIS Health Enterprise Portal to request their list of exchange files. NH MMIS sends EDIFECS (the EDI system), the primary user credentials for the trading partner. The credentials are validated to ensure that the trading partner exists and has the proper approval to access the data in the EDSG Mailbox. Once the validation has completed, a list of outbound files is returned to NH MMIS and New Hampshire MMIS Health Enterprise Portal displays this list to the trading partner. After the trading partner selects a file, a transfer request is sent to obtain the information from the EDSG Mailbox and the data is sent back to the New Hampshire MMIS Health Enterprise Portal to be downloaded.

Note: For additional information on Secure FTP Setup and Support, reference the companion documents.

 

See Also