Using web browser for file transfer from/to Inter Valley Health Plan are easy and secure. Require no extra software.

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Please review the file layout before downloading. You can get the file layouts through the file layout section below.

Files Layout:

The following data files may be accessed for your reference:

ICD-10 takes effect Oct. 1, 2015: All 837 HIPAA transactions with service dates after Oct. 1, 2015 will use ICD-10 codes to bill all healthcare claims including encounters. Based on the ICD-10 requirements, we have developed a process to test with all trading partners. We also created a document which highlights the main changes for professional and institutional 837 HIPAA transaction. To view the ICD-10 change requirements for 837 HIPAA transactions, please click on the following link for the detailed document. ICD 10

IVHP Member Eligibility File: Access Website file name: MEMyyyymm for the monthly Member Eligibility Report. This report lists the benefit and eligibility information for each member. To view a more detailed format click on the following link. Member Eligibility

IVHP Monthly Capitation File: Access website file name: CAPyyyymm for the monthly capitation report. This report lists payment for both current and retro activity for each member. To view a more detailed format click on the following link. Capitation File Layout

CMS Payment(MMR) File: Access Website file name: HFAyyyymm for the payment and adjustment details for each Medicare member of Inter Valley Health Plan. To view a more detailed format click on the following link. CMS Monthly Membership Report (MMR) and CMS Payment Adjustment Reason Code

HCC Part C Risk Adjustment File: Access Website file name: MORyyyymm for the Risk Adjustment Model Output report. The report lists the HCC calculated Part C Risk Adjustment factors for each beneficiary. To view a more detailed format click on the following link. MOR File Layout New HCC Code list

Part B Pharmacy File: Access Website file name: PTByyyymm for the Part B Pharmacy Utilization report. To view a more detailed format click on the following link. PTB File Layout

Part D Pharmacy File: Access Website file name: CALINX_IPAnumber_yyyymm_yyyymm for the Part D Pharmacy Utilization report. To view a more detailed format click on the following link. California Pharmacy Data Standard Format

Quarterly Shared Risk Claims File: Access Website file name: QTRIPyyyymm_yyyymm for the quarterly detailed paid claims paid through current quarter. To view a more detailed format click on the following link. QTRIP File Layout

Vision Service Plan (VSP): To view a more detail 5010 compliant file layout click on the following link. VSP Companion Guide

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Due to HIPAA Regulations, you must use an FTP secured software to be able to download your capitation and member data by using your payee ID number. Web browser downloading is no longer supported. For more information regarding supported Secured FTP Standards, click here.

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