Situation
Claims Rejected
OpenEMR Version
5.0.2-2
Browser:
I’m using: FF 75.0
Operating System
Ubuntu Server 18.04
Logs
Nothing about this issue.
Florida Blue refuses to conform to the x12 standard by insisting on having their Availity assigned sender ID in place of the provider (or facility) ETIN. This hard code gets broken with any revision of the gen_x12 file. It has been like this for a decade and it seems to me that it would be a simple thing to accommodate in the system considering we can make it work with just two lines of hard code! I’ve fought this battle with every version upgrade since 2013 and I have eventually won the battle every time up until now. But this time I’ve run out of time, we won’t be able to make our payroll without some workaround for this issue.
Everyone in Florida using Availity to file Florida Blue claims is familiar with this disaster. We had code that worked in 4.x.x that we put into the /openemr/library/gen_x12_837.inc.php file at loop 1000A (line 98 of the old 4.x.x versions) that looked at the claim and if it was a Florida Blue claim the substitution was made like this;
‘’’ if (trim($claim->x12gsreceiverid()) == ‘470819582’) { // if ECLAIMS EDI
$out .= “" . $claim->clearingHouseETIN();
} else {
if ($claim->payerID()==‘00590’) {
$out .= "” . “yourAvailityBCBS#”;
}else{
$out .= “*” . $claim->billingFacilityETIN();
}}’’’
We found a post from 2015 for v5.0.1 that had nearly the same code except with empty string quotes ("") instead of escaped asterisks ("*") so we tried it both ways, but we still get rejected for the same reason.
This post by @hamd from 2015 says the code belongs at line numbers that identify loop 1000B (in 5.0.2) and it’s missing the asterisks. The post reads;
‘’’ Below is the latest working fix for 5.0.1-6 for this problem.
// Replace existing code with this code in your var/www/openemr/library/gen_x12_837.inc.php file. This is for 5.0.1-6.
// New code is between first and last lines which are shown below for location reference only.
// Use Notepad or Notepad++ for editing. The new code goes into Loop 1000A at line 118 and thus becomes 118-126 (Previously 140)
// Replace BCBS# with your Availity assigned number before pasting.
// Replaces the following code 2 lines
}
$out .= “*” . $claim->billingFacilityETIN();
“ " . “46”;
}
if (trim($claim->x12gsreceiverid()) == ‘470819582’) { // if ECLAIMS EDI
$out .= “” . $claim->clearingHouseETIN();
}else{
if ($claim->payerID()==‘00590’){
$out .= “” . “BCBS#”;
}else{
$out .= "” . $claim->billingFacilityETIN();
}}
$out .= “~\n”;’’’
Then there’s this one, also from 2015; by @fsgl that says “See d. and see c.” with no reference to either found in the post which says;
‘’‘The problem is that there is no place to enter the Florida Blue ETIN in the Facility dialog; cannot use tax id nor SS #. See d. There is no provision for it in the .php file. See c.
Then it goes on to say "Solution is to insert the following snippet; replacing HC279 with your ETIN & saving the change, assuming the Payor ID is 00590 for Florida Blue. Insert the 2 lines between Lines 101 & 102.
} else if ($claim->payerID()==‘00590’) {
$out .= “*” . “HC279”;’’’ Sorry, but this would be the crux of the problem, not the solution.
So the end game is that this code doesn’t work any more, and we need some help with this because something has changed somewhere that invalidates this workaround and we cannot find the solution among all the conflicting posts.
We keep beating our heads against this same problem over and over with each new version.
Would it be possible for us to get some clear direction on resolving this once and for all? Please advise.
David
