s-roach wrote on Thursday, July 18, 2013:
Hello,
I’m getting claim errors in Office Ally for patients that have dual coverage by Blue Cross Sisc III. The secondary claim is being sent out first, instead of the primary. OpenEMR doesn’t show the same problem, in the patients’ billing history, it shows the primary awaiting payment. Not sure what’s going on. Any help, solutions, or incite would be greatly appreciated.
Have a great day!
_Sarah
fsgl wrote on Thursday, July 18, 2013:
Does the X12 text file list the primary insurance first, before the secondary?
In the following example, NGS Medicare is primary and Blue Shield is secondary.
Does the Billing module look like the attachment, where the queuing is in the correct order?
s-roach wrote on Sunday, July 21, 2013:
Thank you for your response!
We are in the second week of switching over our billing to OpenEMR. We had no problem with our X12 partner processing our claims, but this past week, we’ve started to receive denials. We’ve reviewed and reopened the claims. In the drop menu and claim history, the primary and secondary insurances are in the correct order.
In the case of our dual Blue Cross Sisc III insurance patients, we’re created a new insurance provider entry for secondary insurance that is not assigned our X12 partner. We re-submitted the claims Friday and should know tomorrow whether it worked.
This is the second week of switching over to OpenEMR. The problem only arose during our second week. Is there a setting that could of been switched by a user to cause the problem?
Any ideas why the X12 partner is picking up the secondary?
_Sarah
fsgl wrote on Sunday, July 21, 2013:
Sarah, bear in mind that those of us not living in California would not know what SISC III is. I googled it.
You need to explain “dual Blue Cross Sisc III”. Does it mean Medicare and Medi-Cal coverage through SISC III? Exactly what is primary and what is secondary? Are you billing for professional or institutional services?
The Billing Module supports only professional services. The X12 text file is the electronic equivalent of the CMS 1500 form not the UB-04.
If you are billing for professional services and you cannot read the ANSI 5010-X12 837P file, print up the CMS 1500 form and determine if the insurance carrier is correct.
If the CMS 1500 form is correct, what did Office Ally say to be the problem? They can look at the X12 837P and give you a sense of what went wrong.
It is not clear what you meant about setting up the secondary insurance and not linking it to Office Ally.