Hi HT,
Brad explained the EDI claims process very well. The EDI files come in human and computer friendly formats. And I use both of them.
I’m an old software developer turned into a psychiatric nurse practitioner and own my own practice. OpenEMR is perfect for me because I can access the data directly for things like management reporting, disabling the portal when discharged, and automatically posting those cryptic EDI files to the patient ledger.
Wring the EDI interface was not easy and some transactions still need a little manual intervention because while the EDI standard is common, the contents from each payer are not always consistent, but most transactions are clean. OpenEMR does have a feature that allows you to directly post the 835 data to patient ledgers and it works well.
I also use Windows to automatically SFTP X12, 877, 835, and 277 files to/from my clearing house. At the end of each day, I create the X12 file and copy it to my upload folder after the OpenEMR log shows no errors. Sometime I’ll forget to justify a billing CPT4 code with a ICD10 code. Then a Windows task uses SFTP to send the data to my clearing house. I also had to create that process/script. These things are not for non-IT/Development people.
If Brad can do this for you, you may want to consider it. It’s a lot of work. My work is all custom to my environment and uses older technology (I grew up in the IBM world and can only muscle through PHP/Java and have also customized OpenEMR. I use SQL server 2000 (yes it is 2000 not a typo and it still works very well) and Visual FoxPro to interface with OpenEMR to accomplish what I need), but he runs a clearing house and should be creating a module with newer languages for all to use.
Every time I automate something, my day get easier. It lets me focus on prescribing medication, not boring repetitive tasks. My programs run while I’m sleeping 