Medicaid TPL Code

OpenEMR Development
,
#1

Hi
I Have received rejection from Medicaid(When Medicaid is secondary) for TPL Code require In Claim Line level
at Loop = 2330A, Segment = REF2U) and for service line level at Loop = 2330B, Segment =
SVD). So, Kindly help to sort out this issue. and this issue happen only when Medicaid is secondary,

#2

wouldn’t happen to be vermont medicaid?

i changed this to this:

"*";   
  if ($claim->payerID($ins-1) == "MCDVT") { // for 2ndary gmc claims
    if (($claim->payerID($ins)) == "BCSVT") {
      if (($claim->payerName($ins)) == "BCBS NJ") {
        $out .= "H6";
      } else {
        $out .= "EE";
      }
    }  
    if (($claim->payerID($ins)) == "14512") $out .= "MDB";
    if (($claim->payerID($ins)) == "14212") $out .= "MDB";
    if (($claim->payerID($ins)) == "87726") $out .= "MDB";
    if (($claim->payerID($ins)) == "62308") $out .= "OH"; 
    if (($claim->payerID($ins)) == "14165") $out .= "Z2"; 
    if (($claim->payerID($ins)) == "60054") $out .= "92"; 
   
  }
  else {
    $out .= $claim->payerID($ins);
  }
   
  $out .= "~\n";

and this to

"*";
    //for gmc 2ndary claims
  if ($claim->payerID($ins-1) == "MCDVT") {
    if (($claim->payerID($ins)) == "BCSVT") {
      if (($claim->payerName($ins)) == "BCBS NJ") {
        $out .= "H6";
      } else {
        $out .= "EE";
      }
    }  
    if (($claim->payerID($ins)) == "14512") $out .= "MDB";
    if (($claim->payerID($ins)) == "14212") $out .= "MDB";
    if (($claim->payerID($ins)) == "87726") $out .= "MDB";
    if (($claim->payerID($ins)) == "62308") $out .= "OH"; 
    if (($claim->payerID($ins)) == "14165") $out .= "Z2"; 
    if (($claim->payerID($ins)) == "60054") $out .= "92"; 
  }
  else {
    $out .= $claim->payerID($ins);
  }
  $out .=
    "*" . $payerpaid[1] .
#3

does I need to make this change in X12 file?

#4

hi @asharma, just updated the above advice

#5

I have updated .php file as accordingly and sent claim to Medicaid IL now waiting for response from Insurance.

#6

My claim still denied stated that Third Party Liability code not received. So, How can I added TPL code in x12

#7

yeah, there’s probably different codes for illinois, can you find the list of codes from their website?

#8

Yes I have List of Code but how can I add in x12

#9

earlier in this post you can see how the payerid is mapped to the medicaid code in the gen_x12 php script

#10

how can I map for TPL code in X12?

#11

you’re going to have to replace the codes above

#12

that was payer id but how to add TPL code (which is 5 digit numeric code.)

#13

it’s what comes after the above $out .=
for instance MDB