When we import (post) an era into oemr and the era has a denied clam in it. We are running into a situation where open emr zeroes the balance on that encounter. My billers are telling me that it shouldn’t do that. They need the balance for the encounter to remain so they know they have to work the claim some more.
Is anyone else having this issue? If so what are you doing to get around this problem.
hi @bearzillasquatch , what are some of the non-phi details in the 835 for the claim?
The billers here are telling me that the ones that are doing this have a ‘C016’ code in them. I don’t know what that is or if it helps.
But I believe they can choose not to post certain claims in the era while they are in the upload process. It might be that I just tell them not to post claims that are declined(denied?).
I didn’t know when i asked the question that specific claims could be excluded from the era (i think they can).
Hi @bearzillasquatch
Here’s a reference to the denial reasons for the claim receiving the CO16 code. I’m not certain that this is an authoritative reference but it should get you started figuring out which claim you need to exclude from the batch file you submit.
https://www.homecaremag.com/homecare-experts-working-down-denials/december-2017/quick-guide-co16-remark-codes
I could be wrong but I believe that when importing payments from an ERA you don’t have control over which ones are applied, they all are.
If that is the case your remedy is to exclude the bad claims from the claim batch file that you submit.
As far as choosing to not post certain claims the following wiki pages tell how that would be done.
First, this step is how to assemble the claims to be posted.
https://www.open-emr.org/wiki/index.php/OpenEMR_6.x_Billing_-_Claims_Workflows#EDI:_Generate_X12_Claims_In_OpenEMR
When they are all listed on the screen, locate the one with the error in it and simply DO NOT select it. When you generate the list of claims to post, they can be either individually selected (rectangle below) or all selected (oval). If you ‘Select All’, you can exclude the offending claim by de-selecting its checkbox.
Also see end of section ‘Claims Creation’ starting here:
Good luck!
certain checks can be excluded from posting but not claims, started a bug report
testing this PR
@stephenwaite that’s awesome. Thanks.
We got another ERA and I watched the process closely. And there isn’t an option to select which claims to post.
There is a screen that shows what claims are in the era but there isn’t any way to “omit” any of them.
There is a screen that shows the “check” number for the payment. It has a check box which is where i was getting confused.
I’d say that the code change that Stephen Waite has done is probably the solution.
thanks for the report @bearzillasquatch and detailed post @htuck , just committed those changes and will bring back for the 1st patch for 7.0.2