markthepharaoh wrote on Friday, February 27, 2009:
Hey,
Which file that I need to edit to the following items:
ISA06; ISA07, ISA08, GS02, GS03
ISA14?
Thanks for your help!
Mark
markthepharaoh wrote on Tuesday, March 03, 2009:
Hey,
I have found a map for the file header ISA’s layout, however, I don’t know which template file I have to modify for different values of ISA’s to show in the x12 transmitted file? Can anyone help please. Thanks.
Mark
ideaman911 wrote on Wednesday, March 04, 2009:
Mark;
I believe you are using 2.9.1 in Windows, right? That is the one I use. The X12 out of the box is all set to put the proper data in the proper places, with the specific exception of the problems I had with UHC and Aetna which are using the same portal. It seems to be anal retentive on the "HIPAA" rejects, which seem to have no rhyme nor reason, including that their tech people cannot explain. So I used their "receiver ID" code as a temporary "fixer" when those claims submit. You can find that detailed in the forums. I can also tell you that a hyphen in the zip code will cause a reject there. Silly but true. So I omit the "Zip 4" altogether.
In any case, the file in question is the …/library/gen_x12_837.inc.php which interacts with …/library/claim.class.php containing all the functions it calls. Hope that helps.
Joe Holzer
markthepharaoh wrote on Wednesday, March 04, 2009:
Joe,
Thanks, that helps! and you are correct I am using windows XP with 2.9.1. Availity requires certain edits such as ISA06 has to equal AV09311993 with five space bar after that, ISA07=01… and few others! Do you think these are the real reasons or there are other underlying problem?
The submitted claim came back with the following statement
"partner agreement for interchange level could not be found"
When I spoke with them they indicated the edits above and some others!
Thanks again!
Mark
ideaman911 wrote on Saturday, March 07, 2009:
Mark;
The OpenEMR software should be taking care of the data properly, provided you have put it in the correct place to begin with. Otherwise, garbage in… 
I believe the AVO code you have looks suspiciously like a BCBS (and I emphasize the BS patient user code. In OEMR that is listed in the Patient Demographics (you will need to select the "More" to actually view the fields where you enter the info, then select the Insurance checkbox then enter the code in the box labeled "Policy Number", assuming you did not edit that in the Admin - Layout - Demographics listing.
The …gen_x12_837.php file will take whatever the code it finds, and add the spaces to make a fifteen character (including spaces) string which it pastes after the appropriate labels etc needed in the X12 submittal, with "*" as field separators. If you are posting other data somehow, you need to find where and what you entered to begin with.
Just in case, I urge you to verify that you do NOTHING to change logical field identifiers as you edit LABELS. The one big downside to open source is that precisely what allows you to make code do what you want also allows you wreck underlying logic, often without even realizing it. Leaving out a simple "{" will usually result in a white screen. But if you somehow left out a "}" also, the logical change might actually still run, per se, but will look nothing like the intended.
As with most of life - a double-edged scalpel. Hope that helps.
Joe Holzer
markthepharaoh wrote on Sunday, March 08, 2009:
Joe,
Thank you, I had the wrong entries in most of it. I had made the corrections. However, Availity has the same value for GS03 and ISA08 and this is consistent with the program code but it has two different values for GS02 and ISA06 which is inconsistent with the program code. It has also two different values for ISA07 and ISA14 so I made these corrections as well. What I did I created a duplicate for the original file, I saved the original file as original-gen_x12_837 and edited the new file. I submitted the claim and it was accepted at the first stage with success, I will know tomorrow about the next stages! I will post the changes when the process becomes completely successful. Thanks again for your help.
Mark
ideaman911 wrote on Monday, March 09, 2009:
Mark;
Thanks for the info, but did you submit as generated before you changed any CODE once you had properly filled the patient data fields? You might have seen some of my comments about UHC X12 submittals elsewhere, which has been the strictest X12 partner we have found, and the X12 as distributed in 2.9.1dev worked fine in Windows except for the specific problems as noted. And as I noted in my writeups, the rejects at UHC and Aetna (they are actually the same portal) were consistent in failing for an INCONSISTENT treatment vs the rest of the data in the X12, which is why i made the code in my suggested change ONLY affect output if the specific receiver code was used, since other X12 partners had NOT rejected the original outputs.
I only suggest caution on modifying code which has demonstrably worked fine, especially if your data has not been mapped into the correct locations in OpenEMR.
Joe Holzer
voipbound wrote on Tuesday, March 10, 2009:
"The Contractor ID Code must be reported in the ISA08 and in the GS03" is what medicare requires. What is this and where do I put the ID 12202?
markthepharaoh wrote on Wednesday, March 11, 2009:
If this is the ID that the clearing house identifies the insurance company with; This will be the CMS ID, under insurance company. I hope this help.
Do you use Availity?
ideaman911 wrote on Wednesday, March 11, 2009:
Mark;
I believe you are right, and the 12202 he mentions is the CMS Code, since it has five digits.
That gets entered in the CMS Code field for each Insurance Company via Admin - Practice - Insurance Companies then click on the specific company in question. You must have all those fields properly filled in for X12 partners, and you get that info from the insurance company themselves.
One caution - avoid use of Zip+4 codes, or at least omit ANY spaces or hyphens.
Joe Holzer