Generating x12 problem

Support
#1

Situation

Ok, new user here and I feel like I’m missing something really basic, but I cannot get valid x12 files generated. I hit validate and I get this error in the log:

Validating Claim 2-9 existing claim status is not altered.
Generating claim 2-9 for JOE SMITH on 2021-06-01 19:56.
*** Error: Insurance information is missing!
*** Missing insured last name.
*** Missing insured first name.
*** Missing policy number.
*** Missing payer name.
*** Payer ID is missing for payer '*** Missing payer street.
*** Missing payer city.
*** Missing payer state.
*** This claim has no charges!
*** Rendering provider is billing under a group.

Please see attached screenshot where I have entered the relevant information

OpenEMR Version
I’m using OpenEMR version 6.0.0

Browser:
I’m using: Firefox 88

Operating System
I’m using: Docker

Logs
Did you check the logs? Yes
Was there anything pertinent in them? Yes (see above)

patient
patient1583×703 36.5 KB

#2

Hi @srs
It’s hard to tell from this description everything that needs to be fixed to eliminate the errors in the validation log.
To complicate things, the claim validator can get some things wrong, for example, when it says ‘insured last name’ is missing when it plainly is not.
Getting a valid x-12 claim file requires everything being present and correct in several places, and the errors mention more than one of them.

However-- if you’ve made a bunch of changes to the patient’s record and re-run the claim several times, the first thing to do is to get into the billing manager, select the claim and click ‘re-open’ (oval in pic below).
Then click ‘Clear Log’ (rectangle) to empty the claim error log of the errors that were detected for the original state of the claim.

But-- here are the main things that need to be correct to make a valid claim file.

  1. The patient record- Demographics and the insurance info appears to be complete from the screenshot
  2. In the fee sheet of the encounter that the claim file is for, it requires:
  • All CPT codes must be justified by an ICD10 code
  • Be sure the price, the units, the rendering provider, is present
  1. The insurance company listing (main menu: Administration/ Practice/ Insurance Companies) looks complete, but is there an x-12 partner (clearinghouse) associated with that medicare payer? I do know that medicare payers are a special case for submitting claims to but sorry to say I do not know what is different about them.
    Unless you’re submitting directly to the payer it should have a ‘default x-12 partner’ specified.
  2. Administration/ Practice/ X12 Partners - If sending the claim to a clearinghouse it will give you the information needed to fill in the ISA and GS, etc fields here.

I hope the remedy for your problem is as simple as clearing the log and the claim, and re-running claim. If not, please feel free to come back with more questions and I’m sure somebody else can offer suggestions.
Best- Harley

The picture referred to above:

image
image800×460 56 KB

1 Like
#3

Hi @htuck,

Thank you for the detailed reply! It was very helpful when you pointed out what looks correct and what needs to be checked, and indeed there was a problem with the CPT codes. In this case, the error message was misleading and left me looking in the wrong place…