there’s also a very nice EDI module under Fees->EDI History
it wouldn’t take too much work to parse the 999s or 277s into an understandable pass/fail type of human readable report
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I would love to demo my system to you sometime. I used to work as an architect at a clearinghouse, 6ish years ago. I decided to write this system I use today completely from scratch on my own.
I’m still a startup and completely funded by myself as well, so I don’t have money yet for business analysts or something similar. Everything, that I have in the portal today, is just from what I remember old collogues complained about or what I could glean off of a facebook group.
I wouldn’t expect you to use my system, but I would like to brag to another developer that understands what actually goes into all this. Plus I would love advice on how to work more with OpenEMR. I haven’t done PHP since college, which was when php first came out, so my php skills aren’t up to par anymore. So I have a little anxiety thinking about trying to get back into php again. Plus I would like ideas on what to add to the clearinghouse portal that would make it cool to other users that actually use clearinghouses.
My system is written in .Net Core 6 running on google cloud’s serverless environment. The portal is written in the Angular 13. I sadly went with sql server for some of the db stuff. I say sadly, because I made that decision before deciding on the cloud to use and sql server is dang expensive. I should of use Postgres or Mysql. My other reason for picking sql server was because I’m a sql server dba and know it well. I’m not sure I could manage the other options as well. Something else to learn. The processing system itself though run on a nosql database MongoDB. It’s a pretty cool database.
Brad
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Sure I’d love to see it. I see patient’s Mondays through Thursdays, so Fridays are generally good. I’m on the East Coast, so you know what time zone I’m in.
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I’m open all day Friday, send me an email with available times, brad.sharp@claimrev.com and I’ll send an invite for Friday.
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This is great! Maybe one of you could record the session and post it to YT and the link here?
If you’re not familiar with wiki markup, give me the URL of the video and I’ll add it to the OpenEMR wiki.
- HT
I have a demo/slideshow on youtube now. I put it together awhile back and it’s pretty out of date right now. I’ll try and create a new video in the next few days. I’ll post that link here when it’s done.
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V cool. We don’t recommend clearinghouses to our customers but could include any resources you may publish in the list of options they might want to evaluate when they’re picking a clearinghouse.
Plus publishing it here on the forum is really good exposure!
- HT
Thanks for helping me out, here is the link to the youtube video
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I’ve been watching videos and trying to think about integrations for the past couple of days. I know the sftp option is there to send claims from a particular folder. However, there doesn’t seem to be a way to download reports and import them automatically. I watched a video on importing the 835 and wondered if there was a way to access that api some other way.
I had a few thoughts. If I created a .Net Core web application that ran on the same server as OpenEMR. It would be configured to auto download the reports into a configurable folder. I wasn’t sure if I would be allowed to create a web app, I wanted to find out from here. I’m also not sure how hard it is to install said web application on the servers. I’m a programmer and my linux abilities are limited to making linux containers work to run my code. I’ve avoided doing direct installs, I assume it shouldn’t be difficult though.
So, if the service is there and downloading reports to a folder, then if I use an api key, is that an option? I could hit the same urls as the import 835 screens. I didn’t know if this was remotely possible. Maybe somebody has a better idea? I thought about trying to build it in the PHP code, but PHP isn’t my thing and would take me a very long time to figure out.
I’m still looking for where to import 277 files. I got distracted looking at fhir api’s.
Next, if I get any traction from users, I would like to access the appointments fhir api and build a Real Time Eligibility option. This wouldn’t be right away and if I had enough users interested in it, I’d start designing the process.
If anybody would be interested in participating, I’ll give the openEMR community unlimited professional claims at $40 per provider. I would need to talk about your payers and if sending to Medicare, I would need time to get a submitter ID from your MAC if it is not Novitas. If I was charging more a month I would just pay to send claims and then get the submitter id, but since the price is so low, I need the direct send setup first. With Novitas, it only 2 took weeks to get it.
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I have created a module now that interfaces directly with my clearinghouse.
This module will watch the x12_remote_tracker table and send the file when it finds one waiting. Then every 4 hours it will call to my api and download 999/277/835s and place those file in the respective “f” folder, for example “f277”.
There is also a menu item to view claims submitted to the clearinghouse. Today you can search by patient and send date. I can possibly add other search options as requests come in. This screen will also show you the error messages and status of the claim on my end. I have attached an image at the end to show what it looks like currently.
As I get traction and users I’ll start making regular updates and get doing more stuff. Connecting to the new appointment event is my next task, in that will get the patient and run eligibility for them.
Right now, I plan to keep the results in the module and display based on a json response I’ll send back. But I’m up for suggestions as users start using the module.
Here is the package on packageist
Roadmap will include:
- Eligibility
- Insurance Discovery (find unknown insurance)
- Prior Authorization (the automated processes can take hours to get authorization as opposed to weeks)
And here is the current picture of how claims are displayed. Again, if I get customers using it, I’ll be happy to make what changes for what you guys need.
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Thanks for sharing with the community.
Suggest you add a minimum OpenEMR version to packagist requires. Then create package against the release version and update package version as OpenEMR releases new if required.
If I can figure out how I will. So far I haven’t found any examples that look different than what I have right now. but as soon as I figure it out I’ll make the changes.
Actually the min version of openemr does show in conflicts so not an issue.
When creating a package from main, if you add a version tag to mark the release, it should show version in packagist.
Take a look at how I manage my fax/sms git. May not be best or only way to manage but the way I ended up.
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Is the provider allowed to have a copy of the 835 directly from payer or it will be handed first to the clearing house bounced around possibly between other clearinghouses before finally it gets to the provider?
from CAQH webinar I watched it seems that it is passed first to the clearinghouse, and it could be bounced around between multiple clearing houses before provider get to know what happened to the claims. I attached a screen shot from the webinar
if openemr is able to receive 835 is there any video on how to?
hi @Mohammad , currently openemr can only receive 835s through Fees->Posting->ERA Upload. The script there would have to be reworked to automate the process.
You are correct that ERA’s may bounce around; that just really depends on the payer and which clearinghouses they will allow to send to them. Some payers only accept claims from one clearinghouse.
Now on to your question if you’re allowed to get the era’s directly, and again that depends on the payer but the answer is probably yes. But you would have to go to every portal of all your payers and download all the era’s that way.
I’ve found most government payers allow for direct connection, so as for me, I get a direct connection to the medicares around the country; so those claims and era’s are always direct. I find the Blues are the same way. I’ve always been able to get a direct connection for those as well.
The commercial payers tend to enter contracts with a “preferred clearinghouse” and that company makes money on both sides. The payer pays them and in turn they charge the provider. In cases like this I find the cheapest route to get the claims to the payer.
Availity is dominating the industry especially with medicaid, and seems to be the gateway for possibly “single payer”, “national/international” transaction protocol, I see the marching towards that with slowly implementing SNOMED to replace, down the road, ICD10 because SNOMED is international, similar to what they said in the webinar comparing it to ATM machine, if you have a checking account in a small credit union in BFE in the boonies and you go to Paris you can use the ATM machine in Paris to withdraw money from the machine as long as your funds suffice, so the transaction protocol in place is global, same here, they are moving the transaction protocol of 835 to be across the pond from US to global, that is why we are inching towards single payer wether we accept it or not.
So as far as Availity, I think we need to have openemr integrate with it if the project is going to be future proof.
Availity is my competitor, so my module isn’t designed to work with them. There customer service is difficult and takes a long time to work with. At least in my experience.
Medicaid’s usually have a direct connection option, but every state could be different.
What you get with me is easy to reach person and a personal connection. Also, if i have to send to Availity, i handle those phone calls to Availity if files wont process…
As far as integrations, i can add to the module different api connections. Ill setup those connections from whatever gateways are required. I take the cheapest options i can to keep costs down. Which i try to pass along. I also don’t normally charge programming time to make that happen.
Im sure you can find a vendor that will write you a module to connect to availity api’s. But last time i checked with them i was told it was a minimum of $1000 a month for the privilege to have access to actually write the code.
Why Molina ( Almost all Michigan medicaid…I can say 2 out of 3 patients you see in practice) is shutting off their portal and switching it to Availity? this is a government medicaid endorsing Availity all the way, what does that mean?
Just looking up Michigan medicaid. They allow any clearinghouse to connect and send directly to them. I would send straight to them and if they return era’s get them straight from the source.