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