This page contains Indiana Health Coverage Programs (IHCP) companion guides for Health Insurance Portability and Accountability Act (HIPAA) version 5010 electronic transactions. The guides contain structure and specifications for transactions exchanged directly with Gainwell Technologies (fiscal agent for the IHCP). Providers and vendors developing software for electronic data interchange (EDI) may need to view multiple guides.
The IHCP companion guides are updated as needed. See the Change Summary section within each guide for a history of updates. When a system modification is forthcoming, significant changes are conveyed in advance; see the Upcoming Changes for IHCP Companion Guides section of this page.
The IHCP companion guides are intended only to supplement the adopted national electronic data interchange transaction set implementation guides. These implementation guides, published by the Washington Publishing Company, are available through the X12 website. The IHCP companion guides are never intended to modify, contradict or reinterpret the rules established by the implementation guides.
IHCP Companion Guides
| Name | Version | Date Updated |
|---|---|---|
| IHCP Connectivity Guide | 3.5 | October 2024 |
| TA1 and 999 Acknowledgements | 1.7 | September 2024 |
| 270/271 Health Care Eligibility Benefit Inquiry and Response Transactions | 4.0 | March 2025 |
| 276/277 Health Care Claim Status Request and Response Transactions | 3.4 | August 2024 |
| 277U Health Care Payer Unsolicited Claim Status Response | 3.3 | March 2022 |
| 820 MCE Capitation Payment Information Transaction | 4.0 | July 2024 |
| 834 MCE Benefit Enrollment and Maintenance Transaction | 6.1 | March 2025 |
| 835 Health Care Claim Payment/Advice Transaction | 3.4 | August 2024 |
| 837D Health Care Claim: Dental Transaction | 4.3 | November 2024 |
| 837I Health Care Claim: Institutional Transaction | 4.1 | November 2024 |
| 837P Health Care Claim: Professional Transaction | 4.2 | November 2024 |
Notes:
The IHCP companion guide for electronic prior authorization transactions, 278 Prior Authorization Request and Response, is available from the Important Links and Resources page of the Acentra Health website.
The IHCP companion guide for electronic pharmacy claim transactions, National Council for Prescription Drug Programs (NCPDP) D.0 Transaction Payer Sheet, is available from the Optum Rx Indiana Medicaid website.
Two IHCP companion guides for Dual Eligible Special Needs Plan (D-SNP) claim transactions – one for 837I and 837P claims, and one for pharmacy prescription drug events (PDEs) – are available on the Dual Eligible Special Needs Plans page on the IHCP partner website.
Upcoming Changes for IHCP Companion Guides
When system modifications are planned, advance notification is given to allow vendors time to make appropriate changes to their software and perform testing, if needed. The following table describes upcoming changes and notes the applicable IHCP companion guide. For more extensive changes, a preview draft of the affected companion guide is provided. Please review this information and make necessary modifications to your system before the implementation date.
| Affected Companion Guide (With Link to Preview Draft, if Available) | Upcoming Change | Planned Implementation Date |
|---|---|---|
| No upcoming changes at this time |