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EDIFACT message guide · Healthcare and social

IHCLME Health care claim or encounter request and response

The UN/EDIFACT interactive message for submitting health care claims or encounters at the point of service and receiving an immediate response.

Sent by
Healthcare provider or point-of-service system
Received by
Health insurer or funding institution
Standard
UN/EDIFACT · Interactive (I-EDI) message
X12 equivalent
837 Health Care Claim

What is the EDIFACT IHCLME message?

IHCLME is the UN/EDIFACT interactive health care claim or encounter request and response. The directory defines it as supporting interactive submission of, and response to, health care claims or encounters in the point-of-sale environment, for scenarios where an immediate response is appropriate.

Unlike batch messages, interactive (I-EDI) messages are exchanged as a request and an immediate response in one dialogue. A pharmacy or clinic can submit a claim while the patient is present and learn at once what the insurer will pay.

How the EDIFACT IHCLME message worksDiagram of the UN/EDIFACT IHCLME Health care claim or encounter request and response message. Healthcare provider or point-of-service system sends it to health insurer or funding institution. It usually starts the exchange. Inside the UIB and UIH envelopes, the directory D.21A requires, in the . 2 conditional segment groups are listed by their trigger segment.How the EDIFACT IHCLME message worksHealth care claim or encounter request and response: who sends it, where it fits and what the directory marksmandatory1 WHERE IT FITSUSUALLY FOLLOWSStarts the exchangeIHCLMESENDERHealthcare provider orpoint-of-servicesystemRECEIVERHealth insurer orfunding institutionUSUALLY FOLLOWED BYNo business reply expected2 WHAT DIRECTORY D.21A REQUIRESInteractive interchangeUIB … UIZMessage IHCLMEUIH … UITBODY AND SEGMENT GROUPS+ 2 conditional groups, starting with:OTIPSIBlue box: mandatory segment group. Conditional groups are listed by the trigger segment that starts them; a group is sent only when its data applies.Conditional segments outside groups are not drawn.Structure: mandatory segments and groups in the UN/EDIFACT directory D.21A listing for IHCLME. Your trading partner's implementation guide adds itsown requirements.
How the EDIFACT IHCLME message worksDiagram of the UN/EDIFACT IHCLME Health care claim or encounter request and response message. Healthcare provider or point-of-service system sends it to health insurer or funding institution. It usually starts the exchange. Inside the UIB and UIH envelopes, the directory D.21A requires, in the . 2 conditional segment groups are listed by their trigger segment.How the EDIFACT IHCLMEmessage worksHealth care claim or encounter request andresponse: who sends it, where it fits and whatthe directory marks mandatory1 WHERE IT FITSUSUALLY FOLLOWSStarts the exchangeIHCLMESENDERHealthcareprovider orpoint-of-servicesystemRECEIVERHealth insurer orfundinginstitutionUSUALLY FOLLOWED BYNo business reply expected2 WHAT DIRECTORY D.21A REQUIRESInteractive interchange (UIB … UIZ)Message IHCLME (UIH … UIT)BODY AND SEGMENT GROUPS+ 2 conditional groups, starting with:OTIPSIBlue box: mandatory segment group. Conditionalgroups are listed by the trigger segment thatstarts them; a group is sent only when its dataapplies. Conditional segments outside groups arenot drawn.Structure: mandatory segments and groups in theUN/EDIFACT directory D.21A listing for IHCLME.Your trading partner's implementation guide adds itsown requirements.

How to read this diagram: the top row shows who sends IHCLME, to whom, and which messages usually come before and after it. The lower part shows what the directory D.21A itself requires: the envelopes around IHCLME and the segments and segment groups it marks mandatory. Conditional groups are listed by their trigger segment rather than drawn in full. This is the directory's minimum, not a trading partner's requirement: a message implementation guide usually makes some conditional groups mandatory, restricts the codes and may use an older directory.

Expand diagram Download SVG

When it is used

  • Submitting pharmacy claims at the point of sale
  • Reporting encounters in real time
  • Getting immediate adjudication results

Where it fits in the message flow

This message IHCLME Health care claim or encounter request and response

No other message routinely comes directly before or after IHCLME; it is exchanged when the business event occurs.

Structure

Mandatory segments in IHCLME (directory D.21A)

In UN/EDIFACT directory D.21A, the IHCLME message has 14 segment positions arranged in 2 segment groups. These are the segments and segment groups marked mandatory at message level, in order; a mandatory group is shown with the segment that starts it. Segments inside conditional groups are needed only when the group is used. This is the directory’s requirement, not your trading partner’s: each partner’s message implementation guide names the directory it uses, often an older one such as D.96A or D.01B where the structure can differ, makes some conditional segments mandatory and restricts the codes. This structure comes from one published copy of the directory and has not been independently verified: confirm it before you build a map.

  • UIH
  • UIT

Practical example

IHCLME in practice

A patient presents a prescription at a pharmacy. The pharmacy system sends the insurer an IHCLME request with the patient's coverage details and the items dispensed. The insurer responds within seconds with the amount covered and the patient's co-payment, which the pharmacy collects.

Implementation

Implementation considerations for IHCLME

  • Design for fast, reliable connections, since responses are immediate.
  • Comply with health data protection laws.
  • Handle timeouts and retries without duplicate claims.
  • Check which interactive standards insurers support.

How ECOM helps

Automate IHCLME with ECOM

Industry

Healthcare

Secure B2B integration and file transfer for providers, suppliers, distributors and healthcare partners.

Industry

Pharmaceuticals

Orders, ship notices, chargebacks and sales data exchange for pharma manufacturers and distributors.

Solution

Batch and Real-Time Integration

Scheduled batch processing and real-time, API-driven integration on one platform.

Compare X12 and EDIFACT, or see answers to general questions in the EDI FAQ.

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Need help with IHCLME?

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