Billing to Waystar possible?

DirtyCheese6 · February 24, 2021, 4:41pm

Does anyone know if OpenEMR works well with Waystar? Right now we can’t directly post to it out of the box? Which clearing houses does OpemEMR uses for billing processing?

juggernautsei · December 19, 2022, 4:04pm

We are trying WayStar now and the claims are not compatible. @stephenwaite
I will start looking into making this a format selection in the partner section for Processing Format.
Below is what they sent us back as to what is incompatible with their claim processing.

Here are the items which will need corrected in the test file, as discussed on the call. See below:

1: The below segment (Loop 1000A) has too many fields. Below is what is being submitted currently:

  -NM1*41*2*WAYSTAR      ******46*812344400
        Fixed change Line 1657 X12501837P - $out .= "*" . trim($claim->x12_submitter_name()) .

And here is what it should be corrected to:

 -NM1*41*2*WAYSTAR*****46*812344400 (I eliminated the extra spacing that was present as well)

2: They had us to remove the TIN. Remove from the x12 partner from the setting this entry. ID Number (ETIN)

    NM1*41*2*WAYSTAR*****46*

3: There is some added space with the below segment, that is causing the file to read “Z630” as an unrecognized segment:

 -HI*ABK:F411*ABF:
  Z630
    Fixed line 2339 $out .= "*" . $diag_type_code . ":" . trim($diag);

And here is what it should be corrected to:

 -HI*ABK:F411*ABF:Z630

All of these corrections were made in the src/Billing/X125010837P.php
Please re-upload the corrected file into Waystar once you have made the necessary updates.
837 Institutional Claims Version 5010 Companion Guide_V1.5_August 2021 (2).pdf (191.3 KB)

stephenwaite · December 19, 2022, 8:29pm

Hi @juggernautsei , thanks for the report and glad you’re making progress. I think this was fixed in v7 but not 100% on that.

juggernautsei · December 19, 2022, 8:35pm

@stephenwaite
The install that I am fixing is v6. Some very minor stuff. For people still using v6 and want to go to WayStar. These changes will get the x12 to pass their claim check.
I have to check v7 because this user is ready to migrate. I will update here if the file has not been updated.

I see in v7 the code has been refactored. The clearinghouse name has been removed from that loop and the TIN is not in that loop any longer. So, those issues have been solved. Along with the spacing issue.

juggernautsei · January 31, 2023, 9:32pm

@stephenwaite
Waystar has a requirement that the ISA segment be 15 segments and OpenEMR has 16. How can I remove the trailing *: from that segment or anything else for that matter. I have tried the simple of just commenting out segments but the system is coded to compensate so that there is always 16 segments.

What can I do to tell the system to only have 15 segments in the ISA?

brad · January 31, 2023, 10:55pm

The ISA segment is the only segment that is fixed width and not really using the * delimiter to designate actual elements. I would check that it’s the correct length, and something is incorrectly setup. basically, if it’s not the correct length, then the EDI isn’t readable. The ISA is being read kinda like this:
stream.Read(isaLine, 0, 106);

stephenwaite · January 31, 2023, 11:27pm

juggernautsei · February 1, 2023, 3:03am

I ended up modifying line 214 to get the segment count correct. This is what fixed it for me.

  substr($seg, 0, 61) . "*1$this->bat_yymmdd*$this->bat_hhmm*"

github.com

openemr/openemr/blob/a48e9a5c035a4e429f5aa511cef1d654e56fae6a/src/Billing/BillingProcessor/BillingClaimBatch.php#L214

      
        
            foreach ($segs as $seg) {
                if (!$seg) {
                    continue;
                }
                $elems = explode('*', $seg);
                if ($elems[0] == 'ISA') {
                    if (!$this->bat_content) {
                        $bat_sendid = trim($elems[6]);
                        $bat_recvid = trim($elems[8]);
                        $bat_sender = (!empty($GS02)) ? $GS02 : $bat_sendid;
                        $this->bat_content = substr($seg, 0, 70) . "$this->bat_yymmdd*$this->bat_hhmm*" . $elems[11] . "*" . $elems[12] . "*$this->bat_icn*" . $elems[14] . "*" . $elems[15] . "*:~";
                    }
                    continue;
                } elseif (!$this->bat_content) {
                    die("Error:<br />\nInput must begin with 'ISA'; " . "found '" . text($elems[0]) . "' instead");
                }
                if ($elems[0] == 'GS') {
                    if ($this->bat_gscount == 0) {
                        ++$this->bat_gscount;
                        // We increment the ICN to use as the batch counter.
                        // We lose the zero padding to 9 digits but that's okay.

stephenwaite · February 1, 2023, 4:28pm

so would seem that a 9 character field is missing in the ISA that is normally produced

juggernautsei · February 1, 2023, 5:02pm

That is correct.

Here is what the ISA normally looks like:

  ISA*00*          *00*  *ZZ*               *ZZ*               *030911*1230131*1455*^*00501*675212904*1*P*:~

They needed it changed to this:

  ISA*00*          *00*  *ZZ*               *ZZ*               *1230131*1455*^*00501*675212904*1*P*:~

This passes their system.

juggernautsei · February 3, 2023, 3:29pm

@stephenwaite when we submit a batch to way start. There are several errors that come up in their system. I have tried to solve it by commenting out segments in the X125010837I X125010837P files respectively and focusing on the first error. Loop 1000A, where should I look to change this segment?

I have fixed all of these errors.

A new set of errors now.

htuck · February 7, 2023, 7:43pm

Hi @DirtyCheese6
To answer the 2nd part of your original question, I have had comparatively good results with Office Ally, Availity, and Trizetto.
I say ‘comparatively’, because while they all require varying amounts of effort to use (in the order mentioned, easiest to most difficult) once the adjustments are made they do work well and reliably.
Good luck!