Recently, one of my co-workers applied TRUE/FALSE values to a patient’s accept assignment fields in ‘insurance_data.accept_assignment’. The unaffected patients (those without Medicare as an insurance provider) have a “1” value in the field. The facility has the Accept Assignment box checked in Administration>Facilities>Edit Facility.
The problem we’re having is ALL of our Medicare patients, regardless of their accept assignment status, are being billed “YES.” Prior to the table update, we were not having issues with the YES/NO. We had not noticed a problem in billing till after the changes were made to the table.
Any help or suggestions would be much appreciated.
Young folks are fearless. Today was the first time I changed anything in the tables after using OpenEMR for one year. I experimented on the Demo first before daring to attempt the same on my copy.
Assuming that the attachment, which is taken from the Demo, has the correct values, what happens after the restoration?
Thanks for the quick response. It looks like everything is in order with the accept assignment field. I went through a bunch of the wrongly identified accept assignment X12s and it looks like Loop 2300 CLM section is not transferring correctly in the 7th field.
From the wiki site:
“The seventh field is the ‘Assignment or Plan Participation Code’. This is ‘A’ for ‘Assigned’ in OpenEMR, or C for ‘Not Assigned’ in PES.”
Everything is coming up an “A,” no matter if the patient accept assignment status is “yes” or “no.”
You are not overlooking anything. It is not possible using OpenEMR’s current implementation to send anything other than “A”/Yes for “accept assignment” in X12 files.
It looks like the “Accept Assignment” for billing facility can impact Box 27 on the HCFA form, but gen_x12 does not pay attention to it.
In re-reading the consolidated X12 guide, having A in field 7 is generally correct, field 8 will be Y or N depending on the actual assignment state.
The consolidated guide says: A in field 7 is appropriate if:
Required when the provider accepts assignment and/or has a particpation agreement with the destination payer.
OR
Required when the provider does not accept assignment and/or have a participation agreement, but is advising the payer to adjudicate this specific claim under participating prover benefits as allowed under certain plans.
Then field 8 should be Y/N accordingly if
This element answers the question whether or not the insured has authorized the plan to remit payment directly to the provider.
Proper interpretation of the X12 spec is always tricky, so if you determine that you need field 7 to be A or C instead of just toggling field 8 to Y/N (which the code does in fact handle) you are going to need to change the code.
It’s possible that the mucking you’ve done in the database of the accept assignment field may also be a problem, at this point.
If no one in the office knows how to fix the code, hopefully you have a backup that predates the changes to the database and reconstituting the recent data will not be a major undertaking. If you don’t backup regularly, now is a good time to become familiar with the Wiki backup page.