Billing HCFA notes

juggernautsei · October 17, 2023, 6:10pm

The rejection error is this:
X12 Rejected claim error details: REJECTED SUB-ELEMENT SV101-07 IS MISSING. IT IS REQUIRED WHEN PROCEDURE CODE IS NON-SPECIFIC (SV101-02 IS B4185). SEGMENT SV1 IS DEFINED IN THE GUIDELINE AT POSITION 3700.

Digging through the code I found SV1 but I am not sure if it is the same SV1 in the error message.
I don’t know what code they were trying to bill. I will be doing a working session with them later to get a better picture of what they did.

The image above is what I have a question about. The notes on the fee sheet used to show up where I have the blue text. Those notes no longer show up where. Is this a change in the requirements?

stephenwaite · October 17, 2023, 6:16pm

for 837:

github.com

openemr/openemr/blob/master/src/Billing/Claim.php#L1282

      
        
            public function cptNDCQuantity($prockey)
            {
                $ndcinfo = $this->procs[$prockey]['ndc_info'];
                if (preg_match('/^N4(\S+)\s+(\S\S)(.*)/', $ndcinfo, $tmp)) {
                    return $this->x12Clean(ltrim($tmp[3], '0'));
                }
            
            
    return '';
            }
            
            
// Not Otherwise Classified codes require a description on the SV1 line after the modifiers
            public function cptNOC($prockey)
            {
                return in_array($this->cptCode($prockey), Claim::NOC_CODES);
            }
            
            
public function cptDescription($prockey)
            {
                return $this->x12Clean($this->procs[$prockey]['code_text']);
            }

for hcfa:
looks like you have to use the MBO and insert comments

juggernautsei · October 18, 2023, 1:47am

Which box in the MBO is used to do the note for the form?

stephenwaite · October 18, 2023, 10:47am

hi @juggernautsei, it’s the additional notes text box at the bottom

juggernautsei · October 18, 2023, 1:20pm

@stephenwaite, additional information does go in box 19 from the MBO. In my screenshot, I typed in that box. Are you suggesting that the SV1 is box 19? Also, there are no GUI text boxes that are mapped to where I have the blue text. I did not find any in the interface.

stephenwaite · October 18, 2023, 2:47pm

hi @juggernautsei , if you want to send this electronically with an 837 you just have to add the proc to the NOC_CODES array in the claim class and it will grab the description of the code; electronic submission doesn’t require MBO.