MMF Systems has spent a lot of time developing code for edi-270/271 insurance eligibility. Semantically (meaning code is openemr friendly), this code is ready to commit. However, it needs functionality testing and database scheme review by at least Rod and Tony. Was hoping you guys could quickly test/review this code; no need to focus on the actual code (that looks good), just curious on thoughts on the functionality and database scheme. Both a github branch and patch can be found in the tracker (read my last message for instructions on installing patch): http://sourceforge.net/tracker/?func=detail&aid=3019716&group_id=60081&atid=1245239
Functionality is rather simple.
1) Reports->Visits->Eligibility, which chooses patient by date range of their clinic appointment, and creates a file(edi-270) to send to X12
2) Reports->Visits->Eligibility Response, which allows uploading of response file (edi-271) to fill the eligibility information
Then eligibility info can be found for each patient on the patient summary screen in the Insurance section (there is a new Eligibility tab)
Rod and Tony,
Can you guys to a cursory review of this code. Really helpful to know your thoughts on the functionality and the database scheme. This would be an excellent marketing feature, so was hoping to get this feature in to allow enough testing before a 4.0 release.
-brady
Small note:
I downloaded , installed it and generated a test file. I use Softshares EDINotepad to test file structure integrity (Its also free). At least it look good. I will do a test transmit later this week to a CH or Insurance.
And here is my note:
I think this function should be do-able from the patients summary as well. The reason is I have see many offices in which Eligibility is done when the Patient shows up and their record is pulled.
Copy into your OEMR Directory and use the patch command. This will add the new menu items in Reports->Visits. Use the calendar widgets to select a date range for the patient visits and pick a clearinghouse.
Here is a short vid on how to produce a 270 file. http://www.netmedicpr.com/Elegiblidad.swf
You can use the Eligibility Response to upload the 271 file sent by the CH.
Can you test/review this patch/code. The OpenEMR coding semantics are ready for commit, but want to make sure the database scheme and functionality make sense.
Following instructions for getting patch started:
1) Extract MMF-Systems-EDI-270-271-Patch-14-09-2010.zip (has new files)
2) Patch MMF-Systems-EDI-270-271-Patch-13-09-2010.diff
3) Then patch MMF-Systems-EDI-270-271-bugfixPatch.diff
The workflow doc is MMF-Systems-EDI-270-271-workflow-10-09-2010.zip
Looking at today’s comments in the tracker, I take it we are waiting for an updated patch? I will take a look when it’s ready, but I don’t have any easy way to test the interaction with the clearinghouse.
Anyway I looked at the work flow document. It appears the feature is currently batch-oriented and that individual real-time queries are not ready yet. Seems like the most practical way to do eligibility queries is as the patient checks in. I’m curious to know how batch queries will fit into the larger work flow… didn’t see that discussed.
Yep, will need to wait until there’s a workable patch.
A potential workflow would be that each day before clinic started they ran this on the patients scheduled for the day. Of course, checking during patient check-in would be a nice feature, but that is not what this code does (yet). On your review, one of the things I’ve very interested in knowing is your take on the database scheme (and would it be expandable to support updating of features,like checking during patient check in, in the future; just want to make sure no bridges are being burned).