Eligibility Checks & Clearinghouses

Day-to-Day Users
#101

@albanyeye @stephenwaite @KyleNave and others. I brought this project into codebase and have attached a patch for easier testing. Currently I have no plans to back port to 501 unless it is strongly requested. Some points:

  • Some X12 Partner settings have been restored and will populate 270.
    – Sender ID Qualifier (ISA05) and Receiver ID Qualifier (ISA07).
    – ID Number (ETIN) for payer NM108 default is 46 but sometimes PI may be needed.
    – User Logon/User password are for RealTime MIME interfaces currenty Office Ally.
    – Processing format currently doesn’t do anything but will in future.
  • To turn on Office Ally enable in Globals->Connectors.
  • To turn off detailed 271 report downloads after 270 processing Globals-Features->Disable Insurance Eligibility Reports Download
  • The demographics Insurance Eligibility report is very detailed and may require some knowledge of codes. Did best I could without have access to the specs.
  • Eligibility batch is better presented for what patients to request 270s. This is based on whether patient has near time appointments. No appointment, no eligibility request.
  • I have plans to add a realtime request button to insurance Eligibility report tab to get new eligibility status for patients and possible in calendar as well.

I hope this all proves useful and thank you albanyeye and Stephen for your support.
eligibility-patch-master.zip (165.8 KB)

2 Likes
How to Setup insurance eligibility in OPENEMR v5. 0.2
Insurance Eligibility - Error: Receiver Unable to find any users with username ' '
Officeally integration
#102

Thanks!!
Will test it out today

#103

Works!!
thanks again.
So much info in the 271 file.
EDIT:
did not realize the eligibility tab in demographics gets populated.
Thats great.
does the log download features in global need to be turned off for the Eligibiity tab to populate?

#104

No the logging report feature is just in case user wants to keep a record of transactions(plus it took some effort to create, didn’t want it to go to waste). Turn it on if that’s the case. How does the tab report look?

edit: actually if we had the same report from OA portal for a patient then I may be able to make the tab report clearer.

#105

@brady.miller @sunsetsystems @stephenwaite and others

Come on guys! Somebody had to know that this was in the code base! I spent hours trying to get the information that’s in this class and a quick “Hey Jerry, did you see this \library\edihistory\codes\edih_271_code_class.php”!!! couldn’t be mustered up!!!

I feel foolish and why bother trying to create projects involving community support.

#106

Sorry @sjpadgett ,
That is a module developed solely by a prior developer, Kevin McCormick, and most of us probably aren’t aware of all the code in it.
-brady

#107

I know what’s going on here Brady. It’s best I let it go for a while because, i’m pissed right now.

#108

Sorry, I’ve not worked in this area and wasn’t aware of that one either.

#109

This is what I was after and makes for a very readable report. This is partial log from 271 parse. For those keeping up.
medicare-realtime.txt (5.7 KB)

#110

Insurance Eligibility tab

image
image1480×826 116 KB

Thinking about adding global for full report or partial(plan,co-pay,co-ins and deductible only)

#111

Oh my goodness; I think this is the first time I have seen an example of the Eligibility tab actually working since it has been there. Almost brings a tear of joy to my eyes :slight_smile:

#112

Patch for some 271 parsing and update of reporting.
eligibility-patch-parse.zip (11.1 KB) One file.

Note: @albanyeye and @stephenwaite

1 Like
#113

never thought to look there, nice find @sjpadgett, looks great

#114

agreed. This is awesome! :cry:

#115

This is such a nice feature. Thank you for developing it!

I’m using Windows XAMPP server. How can I set this up and try on my system?

Thank you

#116

I’m almost ready for a back port to 501 which i’ll post here til patch 8 is ready. albanyeye has reported some difficulties that i’m not experiencing with Office Ally 270 transactions on 502 so the patch may change in near future.
This will work if you have Office Ally or via batch upload.

#117

Okay attached is the 501 version of this feature. Note:

  • You must run sql_patch.php just like normal patch.
  • I haven’t bumped patch version til official patch release.
  • Patch includes oeHttp client and new vendor dependency Guzzle.

I’ve tested on 5.0.1 patch 7 and don’t see how this install can cause concern on a production site but one never knows so, take precautions.
Let me know of any issues.

Patch removed because the creators a dummy :slight_smile:

#118

I’m so sorry everyone but I blew the 501 patch so for any difficulties, I apologize. I’ll put corrected one up soon. I forgot to commit oeHTTP and update class autoloads.

#119

thanks a bunch Jerry!

#120

Well that’s one more interop out of the way. I’m dieing to get a certified lab into OpenEMR. Software done, lab cooperation is another story…