I’m trying to setup a provider that does not want to accept assignment of some claims (wants the payment to go to the patient, i.e. “courtesy billing”).
Every HCFA/X12 5010 crosswalk that I have seen defines the following:
Box 13 = CLM08
Box 27 = CLM07
Payors predominantly use Box 27 (CLM07) to determine assignment, but may also use the presence of a signature (or not) in Box 13 for that purpose.
In OpenEMR’s default HCFA processing, the signature is always there, implying that payment should always go to the provider.
box 13: hardcoded ‘Signature on File’
box 27: $claim->billingFacilityAssignment()
- “YES” if both billing facility and patient accept assignment
- “NO” otherwise
OpenEMR’s default X12 processing does the opposite, allowing the equivalent of a blanked signature, but the Box 27 equivalent is always “A”, implying that the provider participates/accepts assignment.
CLM07: hardcoded “A”
- “Y” if both billing facility and patient accept assignment
- “N” otherwise
Shouldn’t the $claim->billingFacilityAssignment() function also be used for HCFA Box 13 calculation and X12 CLM07 calculation?
…or am I making a faulty assumption somewhere?