Insurance does not generate properly in X12 and CMS 1500

x12
question
cms-1500
insurance

#1

I have this problem. A patient initially had 2 insurances from her January first encounter. In March, she came in with a new secondary insurance. This insurance starts on March 1, 2017. When the secondary insurance is entered, the old secondary insurance became “Secondary (Old)”.
Because we did not bill the insurance yet for the first encounter, now in March, we started to bill and generate the CMS 1500 form and X12. The primary insurance is selected before generating the claim form. In the form, the insurance shows the primary insurance as the "Secondary (old) insurance data. The secondary insurance area shows the “Primary insurance” data. This wrong insurance causes rejection…

Question: Is there a way to change the Secondary (old) insurance back to Secondary, and delete the “new” Secondary insurance? Or anyone has a better solution? Right now, I have to “Delete” the patient and re-create a new patient with the all the 2 old insurances to solve the problem. However, this process takes so much time.


#2

@stephenwaite any ideas?


#3

hi 2017, what version of OpenEMR are you running? Had you not yet billed the primary insurance for the first encounter? You should be able to choose the insurance you would like to bill in the Billing Manager. Yes, there is a way to change the secondary (old) back to Secondary by choosing Unassigned and Save on the insurance you’d like to remove.

ps thanks for the bump Robert, it’s going to be way cool to have dummy data with these types of insurance scenarios :slight_smile:


#4

I still use version 4.2.2 on Windows 7 Pro. I was trying to bill the primary insurance and that happened. Also, the default insurance was the secondary, and I did changed to the primary before generating the file to be sent to clearing house. Would you elaborate the steps how to change the Secondary (old) back to Secondary? How to get to the "Unassigned and Save? Thanks

Update: I see how it’s done now. By selecting edit and in Secondary insurance, select Unassigned and Save. This will allow he Old secondary insurance to reappear.
Is there a way to modify or delete Old insurance? This is helpful if the front desk staff accidentally creating more than one primary or secondary insurances by typing different effective dates and save more than one time because the first one was incorrect. Sorry for more insurance confusion!


#5

the only way to outright delete the insurance would be to access the database directly so you just change the effective dates to create the proper eligibility, it does seem to have a mind of it’s own at times but be patient and you’ll get it

ps - also looking into v5.0.0 to see if it works better or at least as well :slight_smile:


#6

Thank you. I will try to tinker with the data or delete the patient and re-enter as a new patient like I’ve been doing. Hopefully, there will be options to modify and delete insurance in future updates.

I will try the V5.0 when I have time. I’m sure it’s better then V4.2.2