Medicare X12 Claim Issues

juggernautsei wrote on Wednesday, April 03, 2013:

Here is the modification:

I finally found it after doing a lot of code comparing.

In the Claim.Class.php file

This:

  function referrerLastName() {
    return x12clean(trim($this->referrer['lname']));
  }
  function referrerFirstName() {
    return x12clean(trim($this->referrer['fname']));
  }
  function referrerMiddleName() {
    return x12clean(trim($this->referrer['mname']));
  }
  function referrerNPI() {
    return x12clean(trim($this->referrer['npi']));
  }
  function referrerUPIN() {
    return x12clean(trim($this->referrer['upin']));
  }
  function referrerSSN() {
    return x12clean(trim(str_replace('-', '', $this->referrer['federaltaxid'])));
  }
  function referrerTaxonomy() {
    if (empty($this->referrer['taxonomy'])) return '207Q00000X';
    return x12clean(trim($this->referrer['taxonomy']));

Was changed to this:

 function referrerLastName() {
    return x12clean(trim($this->supervisor['lname']));
  }
  function referrerFirstName() {
    return x12clean(trim($this->supervisor['fname']));
  }
  function referrerMiddleName() {
    return x12clean(trim($this->supervisor['mname']));
  }
  function referrerNPI() {
    return x12clean(trim($this->supervisor['npi']));
  }
  function referrerUPIN() {
    return x12clean(trim($this->supervisor['upin']));
  }
  function referrerSSN() {
    return x12clean(trim(str_replace('-', '', $this->supervisor['federaltaxid'])));
  }
  function referrerTaxonomy() {
    if (empty($this->referrer['taxonomy'])) return '207Q00000X';
    return x12clean(trim($this->supervisor['taxonomy']));
  }

The above code delivered what the client wants as far as the provider being that which is entered from the fee sheet and not the referrer that is in the demographics. Because the referring physician that is in the demographics may not be the same physician that orders a proceedure. So, the referrer that is entered by the billing person is the one that should be used for billing purposes and not the referring physician that sent the patient initially.

I think we can put this to bed for me….

Sherwin

robertrambo wrote on Wednesday, April 03, 2013:

Hello Sherwin

About the git are you on windows or *nix?

The flat files in excel for 837 I&P are here ->
http://www.cms.gov/Medicare/Billing/MFFS5010D0/Downloads/837IandPeditSpreadsheets.zip

The reference page is located here ->
http://www.cms.gov/Medicare/Billing/MFFS5010D0/Technical-Documentation.html
The above also links to pdf if you prefer ^

If you use the flat files its a little confusing which are the institutional and professional  its spelled out in the file name!

-Rob

juggernautsei wrote on Wednesday, April 03, 2013:

Rob,

I am on windows. I finally got the git to work. I was trying to push too much at once. I will have to figure out a way to just upload my modification for review.

https://github.com/juggernautsei/openememr you will see the claim.class.php file I was talking about.

Thanks for the info.

Sherwin

yehster wrote on Wednesday, April 03, 2013:

https://github.com/yehster/openemr/commit/7545b3dfc363f3d281c6383d4c48a3e02a19d7fd
Here’s what I expect you are trying to do.
The sequence of “git commands” I used were as follows.
1. git checkout master -  (get back to the “base state”)
2. git branch x12_ref_provider- (create a new working branch)
3. git checkout x12_ref_provider- (work with the new branch.)
at this point, I copied the two files you changed into the source tree in the proper location
4. git add . (tell git about changed files… (there is a dot/period in that command to indicate the current directory)
5. git commit -m “Sherwin changes”  (commit with Sherwin changes as the message)
6. git push git@github.com:yehster/openemr x12_ref_provider (push the changes to my github the x12_ref_provider branch in my repo).    “git push git@github.com:yehster/openemr” without specifying the branch would have worked too, but that would push all of my branches, when I only wanted to update this one branch.  (if you don’t have a bunch of branches like I do, just push would be fine…)

tmccormi wrote on Wednesday, April 03, 2013:

If your “origin” is set you can simplify the branch push to:

git push origin branch_name

-Tony

juggernautsei wrote on Thursday, April 04, 2013:

I just recieved confirmation today that the code afore mentioned has resolved the issue with the billing and the referring physician being the one from the fee sheet and not the one from the patient demographics. It would be nice to have a better “Fix” for this that is a setting that could be changed because clearly their and differences on how a practice may need to populate this field in the claim.

Sherwin

robertrambo wrote on Thursday, April 04, 2013:

Hello

I git it now
Glad you got yourself fixed up

-Rob