We are a Podiatry Practice and we would like to be able to submit X12 files to Medicare for Electronic Billing using OpenEMR to generate the file. I have generated the x12 files and received rejections from Medicare. My latest rejections involve the X12 file missing the required ICD references to go along with the performed procedures. Please assist. We were able to successfully send X12 files to Availity for billing from private insurers, our only hiccup right now appears to be Medicare. Hopefully there are some quick modifications that need to be made. IF that is not the case. We would be willing to pay something for the assistance to get us up and going. My contact information is below. Thanks.
Thank you for the quick response. Oh wow I don’t have the justify column in my version. Did I miss a patch? I didn’t upgrade to 4.2 yet. Well that is weird. does the Justify column add itself after you have added the icd9 codes, exit the patient, then return? I just returned to my trial patient and the justify column was there waiting for me to enter the corresponding diagnosis.
The justify process has been there since the beginning (at least version
2.97)
Tony
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What I noticed is that in a correctly submitted X12 file using another program our submitter ID is placed directly after the company name like:
NM1412MIDWEST FOOT CARE LTD*****46Submitter ID
Now OpenEMR creates the same line, but instead of Submitter ID use our TAX ID. It is pulling the tax ID from the Tax ID listed under the Facility information. How do I force OpenEMR to pull the submitter ID instead?
Based on our understanding, from error-2.pdf file (which is a 999 acknowledgement from medicare), it looks like there were two claim errors occurred for the patient ‘7062-28981’
“Submitter id” is missing. It should be used when the provider directly send the claims to Medicare. Submitter ID, which Medicare provides to the provider, should be configured in OpenEMR. While claim generation (only for medicare), this Submitter ID should be used instead of Tax ID.
“Insured Group or Policy Number” (2000B/SBR03) should not be used for Medicare and it must be blank.
Thank you for your input. My question regarding your point 1 is that, OpenEMR is pulling the TaxID from the facility information. So how would i distinguish for the claims to pull the Submitter ID number for Medicare instead of the TaxID number? It certainly would be very time consuming to keep adjusting facility information for every individual claim submitted. I am looking at this issue incorrectly? Thank you for your help.
fsgl Thank you again. I understand the 1000A and 2310B loop explanations. My questions are regarding the proper location for the X12 information required being entered into OpenEMR. At this moment in time it appears that when OpenEMR generates an X12 file the TaxID information for the Billing Facility is pulled from the TaxID I had entered in Facility information. This information is used in the 1000A Loop that requires the Submitter ID for Medicare. Is that a glitch? Or Am I just confused in the location that I should be entering the Submitter ID? Hopefully my question makes a bit more sense.
Is it possible for you to upload the claim that got rejected with de-identification (you can modify the sensitive elements)?
We did further analysed on the error-1.pdf, and here goes our additional findings.
The error has also occured in the LOOP 1000B NM109, which says for Medicare (Ref: Link to zip file) “The Receiver ID in both the NM109 and GS03 must be equal”.(refer screen shot).
So i’ve attached 5 files. 1 is a successful claim submitted to Medicare using our current billing software. 2 is the unsuccessful claim submitted to Medicare using OpenEMR. As you can see some of the key information required is not in the correct locations (NPI, Submitter ID, TAXID). The next 3 are snapshots from OpenEMR that is used to generate the X12 file. Please ignore the SBR03 error as well as the claim error. I resolved those with your help already. Thank you for looking.
Also, we submit these claims directly to Medicare, not to Availity first. We only use Availity for our private insurance payers.
While comparing the files, medicare code doesn’t match (1000B NM109 and GS03) in unsuccessfull file, and it is same in successful file.
please follow our previous steps to resolve it and share your comments.
For your additional information (error-2-2.pdf),
1, No ICD found (HI Segment)
2, ICD mapping not found in SV1 (SV107)
For your easy understanding, here goes the different errors you’ve faced and the solution discussed.
From error-1-2.pdf
Error: Loop 1000 B - NM109 [Implementation Pattern Match Failure]
Issue: For Medicare (Ref: Link to zip file) “The Receiver ID in both the NM109 and GS03 must be equal”.
Solution: Match the value in GS03 and ETIN same in X12 partner for medicare.
Error: Loop 2000 - SBR03 [Implementation Dependent “Not Used” Data Element]
Issue: SBR03 should not be used for Medicare.
Solution: To remove the same
From error-2-2.pdf & error-3-2.pdf
Error: Loop 2300 - HI [Required Segment missing]
Issue: ICD is not included in the claim
Solution: Include ICD in FeeSheet
Error: Loop 2400 - SV107 [Segment has data element errors]
Issue: ICD is not associated with CPT
Solution: Associate ICD with CPT in FeeSheet