Medicaid rejecting 5010 x12

jmager wrote on Tuesday, January 31, 2012:

Hey folks,

We are using version v4.1.0 (6) and using version 005010X222A1 to create the x12 batch file. 

We are getting are medicaid claims rejected by medicaid for the following:

1. They need the Taxonomy # for the billing provider.  (Not sure where we put this?)
2. They need the TPI # for the referring provider. (Have no Idea where this would go?)

The Medicaid claims are passing Availity checks.

When I look at the x12 batch file I only can find one place where it has the Taxonomy #

~PRV*PE*PXC*207V00000X

All of our other claims to Private Insurance and Medicare are being accepted.

Has anyone had this issue, or does anyone know how to fix it?

Thanks for any information that you can give me!!

jojohit wrote on Tuesday, January 31, 2012:

Is this in Texas ?

jojohit wrote on Tuesday, January 31, 2012:

If it is then that must be the Texas Provider Identifier

https://www.google.com/#sclient=psy-ab&hl=en&source=hp&q=tpi+medicaid&pbx=1&oq=tpi+medicaid&aq=f&aqi=g-v1g-j2g-b1&aql=&gs_sm=e&gs_upl=22839l23893l2l24067l8l3l4l1l2l0l96l242l3l8l0&bav=on.2,or.r_gc.r_pw.,cf.osb&fp=16780516c6f2499e&biw=1294&bih=736

I think it is similar to an NPI. I am not sure why Texas has their own since NPI means National Provider Identifier.

The Taxonomy field is in Administration | Globals | Users.

JP

juggernautsei wrote on Tuesday, January 31, 2012:

Hi,

We are in virginia and we are having the same type of problem with claims being rejected.
Here is what Dr. East’s office manager sent to me.

Hi Sherwin,
Attached is the Upload Claim Summary report that I obtained from PayerPath and provided to Donna.  She uses this report to view what claims have been rejected and for what reason they have been rejected.

Most of the rejections came from Medicare for such reasons as “referring physician required (as if not provided)”.  The referring physician is within the OpenEMR but is not transmitting or populating into PayerPath.  Medicare is the only carrier that is now transmitting in ANSI 5010 format.  This could have something to do with it.  Additionally, under the Medicare section for the patient Jxxxx Nxxxx, there was a rejection for “Patient Date of Birth - Not A VALID  DATE (17410629)”.  However, within our OpenEMR we have the birthdate as: 1941-XX-29.  Hopes this helps.

Any thoughts?

Sherwin
openmedpractice.com

jmager wrote on Tuesday, January 31, 2012:

Thanks for the Reply…Yes it is in Texas.

Any Idea where we would put that TPI #?

Also, we do have the Taxonomy number in the user (Provider).  Where would you put the Billing Provider Taxonomy. 

We are the Rendering and Billing Provider and  in the Facility we have the Billing Location and Service Location checked.

Thanks so much for the reply…