Help with 270 eligibilty and Payer ID

Day-to-Day Users
1

vambati wrote on Wednesday, January 04, 2012:

Hello,

We are using Openemr 4.1.1 dev version in our practice and we use realmed as a clearing house.

we are trying to generate 270  sending it to clearing house.

we are setting the insurance company payer id in the CMS ID field when setting the insurance company under Administration->Practice->Insurance Companies

but in the 270 that CMS ID is not getting reflected as the payer ID. instead it shows the X12 partner receiver id as the payer id in the 270. like the following line from the attached 270 file.

NM1*PR*2*BCBS *****46*262692229 - this number should be what we specify in the CMS ID field of the insurance company, instead it shows the X12 Partner receiver ID.

Here are the contents of my 270 file:

ISA*00*0000000   *00*0000000000*ZZ*262692229      *ZZ*262692229      *111216*1448*U*00401*000000001*1*P*~^GS*HS*262692229*262692229*20111216*144839*000000002*X*004010X092A1^ST*270*000000003^BHT*0022*13*PROVTest600*20111216*144839  ^HL*1**20*1^NM1*PR*2*BCBS *****46*262692229^HL*2*1*21*1^NM1*IP*1*Lake Cardiology, P.A.*Administrator*Admin***XX*^REF*4A*^HL*3*2*22*0^TRN*1*1234501*9000000000*5432101^NM1*IL*1*COMMANS*BETH*B***MI*224849923^REF*EJ*5^DMG*D8*19500122^DTP*472*D8*20111216^EQ*30^SE*15*000000003^GE*1*000000002^IEA*1*000000001^

can you please help me how to resolve this.

Thank you very much.
venkat

2

yehster wrote on Wednesday, January 04, 2012:

In tracing through the code, in edi.inc and edi_270.php, it doesn’t look like the current code supports setting that field to anything other than an X12 partner *sender* ID.
From edi.inc

	if($nm1Cast == 'PR')
	{
		$NM1[1] = "PR";						// Entity ID Code - Payer [PR Payer] 
		$NM1[2] = "2";						// Entity Type - Non-Person 
		$NM1[3] = $row["payer_name"];		// Organizational Name 
		$NM1[4] = "";						// Data Element not required.
		$NM1[5] = "";						// Data Element not required.
		$NM1[6] = "";						// Data Element not required.
		$NM1[7] = "";						// Data Element not required.
		$NM1[8] = "46";						// 46 - Electronic Transmitter Identification Number (ETIN) 
		$NM1[9] = $X12info[3];				// Application Sender�s ID 
	}
3

vambati wrote on Thursday, January 05, 2012:

yehster,

Is it easy to fix this i.e to set

set  $NM1 = CMS ID

please let me know.

4

yehster wrote on Thursday, January 05, 2012:

No it’s not that simple to fix.  I can’t accurately scope out the problem right now.  Honestly, I didn’t even know what an X12 270 was until yesterday.

MMF systems wrote the code that handles this EDI.

5

tmccormi wrote on Thursday, January 05, 2012:

Venkat attempted to contact MMF before posting here at my suggestion, but they have not answered or return call or emails to their support line as yet …
-Tony

6

rnagul wrote on Thursday, January 05, 2012:

Based on our research the call 270 needed mods to make it work wih availity.
If this is not urgent way dev lead can get you the answer. He is outta town and will be back
Monday.

Ramesh
DrCloudEMR

7

vambati wrote on Thursday, January 19, 2012:

this is what I did to solve this problem:

in edi_270.php
in the select I added
c.cms_id as cms_id

and in edi.inc
change $NM1 = $X12info;  to $NM1 = $row;

please let me know if this is the right way to fix.