markthepharaoh wrote on Thursday, April 02, 2009:
Hey,
I had a medicare rejection, I was told that the whole segment that has the "supplement insurance address" has to be removed. Any idea if this sounds right and if it is! the segment is at loop 2330B N3 and N4? any idea where is this and how it can be removed?
Thank you all for your help!
Mark
tmccormi wrote on Tuesday, April 07, 2009:
I’m doing a medicare test with Availity this week, I’ll let you know what the results are and if the code needs tweaking.
–Tony
tmccormi wrote on Tuesday, April 07, 2009:
So I got similar results, need to dig in to the gen_x12 code now.
1. 2330B; N3; N4 - Line 45 & 46 - Other Payer Address is present.
Please remove.
This one is strange as it’s working fine in commercial claims
Other -
1. PRV03 invalid - value too long - 207Q00000X.
2. PRV04 is missing - Should be a Taxonomy code.
–Tony
sunsetsystems wrote on Tuesday, April 07, 2009:
This sounds a lot like something I worked on recently for a client regarding paper claims for Medicare secondaries. Medicare (at least in Indiana) was requiring the primary payer info in section 11, and nothing in section 9, basically violating the spec.
Currently I don’t have a client asking me to investigate it for electronic claims. But the first step would be to get the Medicare requirements in writing.
tmccormi wrote on Tuesday, April 07, 2009:
I’ve sent a request to my Availity tech to clarify the issue.
–Tony
ideaman911 wrote on Tuesday, April 07, 2009:
Folks;
We ran into the same kind of issues with the UHC/Aetna portal. Even THEY could not explain why. It just WAS rejecting.
So I built a routine and published it earlier which would check if the X12 was going to the Receiver ID match, in which case the errant code would change the printing, while leaving all else as distributed. That has been working fine for two months now. I put the same tests in the 3.0.1 distribution (along with setting the style back to Radio Buttons since the tree view seems to prevent access to two features we use, and changed the 3.0.0.1 to read 3.0.1, both within globals.php)
Joe Holzer Idea Man
http://www.holzerent.com
tmccormi wrote on Wednesday, April 08, 2009:
This is the issue - which was fixed in CVS on March 4th
-------------------------
// Payer address (N3 and N4) are added below so that Gateway EDI can
// auto-generate secondary claims. These do NOT appear in my copy of
// the spec! – Rod 2008-06-12
<bold>if ($claim->x12gsreceiverid() == ‘431420764’) { // if Gateway EDI</bold>
etc.
-------------------------
What’s missing the the earlier version is that IF statement for Gateway …
Thanks for the help Rod.
–Tony
tmccormi wrote on Wednesday, April 08, 2009:
Sorry about the html tags …
markthepharaoh wrote on Wednesday, April 08, 2009:
Gentlemen,
Thank you for the input but I am lost? What is the bottom line? I thought of commenting the segment that have N3 an N4 it is around line 658? What do you think?
Mark
tmccormi wrote on Wednesday, April 08, 2009:
Mark,
You could comment it out or add the IF statement around it or, better, just download the current version of the gen_x12_837.inc.php file and put it in place. Any of those will fix the problem.
–Tony
markthepharaoh wrote on Friday, April 10, 2009:
Tony,
As you might have seen that I made changes to gen_X12_837.inc.php to be able to submit to availity, that being said, my question is if I use the new version 3.0.1 would it work out of the box? because of your statement above of replacing the old one with the new version or I have to make the changes that I made before? Thank you all?
Mark
tmccormi wrote on Friday, April 10, 2009:
I have not had to make any changes to gen_x12, just to billing_process.php for Availity. What changes did you make?
If you are running 2.9 it’s probably fastest to just comment out that bit of code for the N3/N4 section.
–Tony
markthepharaoh wrote on Sunday, April 12, 2009:
Thank you Tony, Rod, and Joe! I will try it out and let you know the outcome!
Mark