Clearing houses

drbowen wrote on Wednesday, April 22, 2009:

I am frequently asked questions about electronic clearing houses and wanted to post this on the oemr.org web site.

Which electronic clearing houses are known to work with OpenEMR?

I know of:

Proxymed
Zirmed

There is a previous "list of supported CH" but I am not sure where this list is?

Are there any specific problems with:

Medicare?

Medicaid?

Private 3rd party?

Workers comp?

Sam Bowen, MD

bo2999 wrote on Wednesday, April 22, 2009:

Hi Sam,

Currently, there is only X12 and paper support in Openemr.  However, if we could submit the claims with HCFA 1500 in text format, then most  if not all clearing houses will be able to map all the fields on the that format to transmit to appropriate health plans.  Text files were generated using freeB, but later dropped in version 2.9 and above.

I have been using Office Ally service for FREE over 2 years using openemr.   I also use Claimsredi recently because one of the medical group (HMO) required for all the claims to submit to that clearing house. They were able to mapped all the fields from openemr HCFA Text output without any problem.

I have made some changes for openemr to output claims in text format for compatibility with clearing houses able to use them for openemr version 3.0. It is in the patches section of this forum.  There is an extra button for HCFA text output and all other functions remain unchanged!

See link:

https://sourceforge.net/tracker/?func=detail&aid=2770036&group_id=60081&atid=493003

Bo,

anonymous wrote on Thursday, January 07, 2010:

Sam, what is the contact info for Proxymed? Is it http://www.2kmedicalbilling.net/contact.html?

ideaman911 wrote on Thursday, January 07, 2010:

Sam et al:

We are not billing clearinghouses.  We bill the payer portals directly, eliminating the clearinghouse costs.  We had to make a few adjustments to the gen_x12 PHP file to get past the HIPAA filters for United Health Care and Aetna (they use the same portal), so we have a contingent substitute when their payer code is found.  But we have no problems with most of our other X12 portals.

Medicaid we have to manually write their specific pink form because even Medicare, which is supposed to be regulated by the same CMS, cannot pass along when they are prime.  Stupid.

We worked for MONTHS trying to setup X12 for Medicare, which kept insisting they wanted a corporate name for OpenEMR until they finally decided to accept MY name as the contact.  THEN they informed us there would be charges for using the X12, so we reverted to the CMS 1500 forms again as they are cheaper for our limited submittals.

I spoke with a few clearinghouses, and they all seemed to map from CMS 1500 image, which is exactly what OpenEMR actually produces as a PDF.  So those should be able to be submitted directly as PDF files, based on what they said.  Mind you, again, we do not actually use clearinghouses, though.

Not sure if that helps, but…

Joe Holzer    Idea Man    315-622-9241     im@holzerent.com
http://www.holzerent.com

sraj49 wrote on Thursday, January 07, 2010:

Hey Joe,

Very interesting. What kind of tweaks did you make on gen_x12 PHP file for Medicare…Can you share the information please?

Raj

ideaman911 wrote on Friday, January 08, 2010:

Raj;

I didn’t make any because they dropped the bomb on me of charges.  The entire exercise was a pain.  But looking at the file, it certainly seems it should be OK as-is, just as it is for every other payer we have except the UHC-UBH and Aetna.  However, I do not KNOW that for a fact.  Sorry.  If there were problems, though, I would take the same approach, using a contingent handler when it saw that payer code, at each subsection as needed.

I can tell you that our NGS operation insisted that we put the claim date in the “Signature on File” (I think that is box 31) on the CMS 1500, despite the fact their own forms says otherwise.  So one never knows.

Joe Holzer    Idea Man    315-622-9241     im@holzerent.com
http://www.holzerent.com

michaelsheridan wrote on Monday, January 11, 2010:

I have been submitting test claims to OfficeAlly for the past week or so, with good success, using the X12 file generator.  They can accept either than or the HCFA 1500 image, but said they preferred the X12 as it reduces processing on their end. 

I am still struggling with a couple of setup errors which I think are owing to my own ignorance (see other thread), but my files seem to be making it into the OfficeAlly system just fine.

Hope this helps.

Mike

sraj49 wrote on Monday, January 11, 2010:

Thanks Joe. thanks for the information. One of my friend has a Psychiatric practice and I recommended openEMR to him. Is there any forms specific to Psychiatry practice? are they in the forms list under contib/forms? Is it possible to share the info. Thanks.

Raj

ytiddo wrote on Monday, January 11, 2010:

Raj,

At youthbridge, we are currently developing  aseries of forms for our mental health services, (hopefully) compliant with medicaid needs in the state of arkansas.

notice how specific i had to get there? requirements for mental health forms vary by payor funding source, therefore, its going to be real hard to come up with a generally useful set of psychiatric forms.

you’re welcome to what we’re building here. I’m building up a form generator at http://openmedsoftware.org/wiki/OpenEMR_Xml_Form_Generator . please take a look at it, and tell me whether it looks useful to you.

Good Luck,

Justin Doiel