CLIA number not transmitting to clearing house


(Peggy Guillory) #1

Situation
My Humana medicare replacement claims for CLIA waved testing is rejecting from the clearing house, Availity. CLIA number is in system under “Facility”. We have not had this problem with regular Medicare or any other Medicare replacement. Is there a functional in code that allows for this for Medicare but possibly not set for “commercial carriers”

OpenEMR Version
I’m using OpenEMR version v5.0.1 (7)

Browser:
I’m using: Chrome

Operating System
I’m using: Windows 10 Home

Logs
Did you check the logs? Was there anything pertinent in them? Paste them here (surround with three backticks (```) for readability


(Stephen Waite) #2

hi @PeggyG, you guessed it, so you could either code those insurance companies as medicare in admin->practice->ins co or edit the code, openemr/gen_x12_837.inc.php at rel-501 · openemr/openemr · GitHub


(Peggy Guillory) #3

Thank you. Stephen This week we are also now having the same problem with an employer driven UHC plan. I guess now all commercials will start requiring clia #'s on all claims that need one. I am having Jeff review your direction to help with the code. He will probably be in touch with you.


(Stephen Waite) #4

hi @PeggyG, ok, feel free to take out the second part of the if condition on the first line so would just be

if ($claim->cliaCode()) {

for now


(Jeff Guillory) #5

Stephen are you telling me to put this code:

if ($claim->cliaCode() && ($claim->claimType() === ‘MB’)) {
// Required by Medicare when in-house labs are done.
++$edicount;
$out .= “REF” . // Clinical Laboratory Improvement Amendment Number
" . “X4” .
"
” . $claim->cliaCode() .
“~\n”;
}

in this file:

openemr/library/ gen_x12_837.inc.php

at line:

564

??


(Stephen Waite) #6

hi @nursejeff, it’s easier to change the payer type for each insurance you have a clia issue with. So go to Admin->Practice->Ins Co and change payer type to Medicare Part B so that it will grab the CLIA.