How to configure for ClaimMD Eligibility Check

Management and Administration
2

OpenEMR: Version Number: v5.0.2 (1)

I solved my issues regarding single eligibility checks using Claim.MD.

This particular post led me in the right direction:

Eligibility Checks & Clearinghouses

Where Kyle states:

“It did require a few changes to edi.inc and edi_270.php.”

I started with edi.inc. I made several modifications:

First of all, my 270 submission to Claim.MD was failing due to missing an NPI value. Here are the 271 results:

<result>
<error error_code="430" error_mesg="Provider NPI [XX] has not been configured in Claim.MD." />
</result>

I resolved the above error by changing the following line:

From this:

170: $NM1[8] = "XX";

To this:

170: $NM1[8] = $row['provider_npi'];

Next, I stumbled across this stack overflow post:

It was brought to my attention that the:

“Passing in the “body” request option as an array to send a POST request has been deprecated.”

The example code provided in the post led me to modify the following lines:

From this:

826: $response = oeHttp::bodyFormat('body')
             ->usingHeaders($headers)
             ->post('https://www.claim.md/services/elig/', $mime_body); // @TODO put request urls in x12 partner's for versatility.

To this:

826: $response = oeHttp::bodyFormat('form_params')
             ->post('https://www.claim.md/services/elig/', [
                 'AccountKey' => 'XXXxxxClaimMD_APIKEYxxxXXX',
                 'UserID' => 'ClaimMD_UserID',
                 'File' => $x12_270,
         ]); // @TODO put request urls in x12 partner's for versatility.

I also added this line:

now line 838: $xml = simplexml_load_string($formBody);

Because the format of the Claim.MD 271 reply is much different than what was originally expected:

I comment out these lines (formerly starting at line 838):

/**

        if (!$cksum) {
            $errors .= "Error:" . xlt("Request Content Fails Integrity Test");
          }
        if ($response->status() !== 200) {
            $errors .= "\nError:" . xlt("Http Error") . ": " . $response->getReasonPhrase() .  " : " . $response->status();
       }
    if ($formData['ErrorCode'] != "Success") {
        $errors .= "\nError:" . $formData['ErrorCode'] . "\n" . $formData['ErrorMessage'];
    }
    if ($errors) {
        $errors .= $formData['Payload'] ? "\nError:" . $formData['Payload'] : '';
        return $errors;
    }

*/

… and replaced them with these:

if ($response->status() !== 200) {
    $errors .= "\nError:" . xlt("Http Error") . ": " . $response->getReasonPhrase() .  " : " . $response->status();
}
if (!empty($xml->error[error_code])) {
    $errors .= "\nError:" . $xml->error[error_code] . "\n" . $xml->error[error_mesg];
}

if ($errors) {
    $errors .= $formBody ? "\nError:" . $formBody : '';
    return $errors;
}

Since I’m not using the mimeParse function on the 271 response from Claim.MD:

I changed this (formerly starting at line 854):

return $x12_271;

To this:

return $formBody;

With the above changes, I have an acceptable 271 Eligibility response.

However, I’m currently working out an issue with Claim.MD support where their 271 Eligibility Response is missing Subscriber Demographic Information.

Specifically, the following 2 Element IDs:

  • DMG02, Subscriber Birth Date
  • DMG03, Subscriber Gender Code

Because of that, OpenEMR throws the following error:

Error: Unknown Transaction Error Maybe Subscriber Effective or DOB Date

I’m temporarily resolving this problem by appending some logic within this function (formerly line 891):

function parseEdi271($content)

Since we already have a handle on the policy number, I perform a quick lookup to obtain the DOB:

"SELECT subscriber_DOB FROM insurance_data WHERE policy_number LIKE ?";

I store the DOB value in a variable and only use it when DOB is missing from the 271 Eligibility Response.

NOTE: I haven’t even ventured into bulk Eligibility Requests yet. I believe I will have to look a little closer at the edi_270.php.

Maybe these quick modifications might be able to assist those having similar issues.

All the best!

Henry