Multiple CAS Segments

Management and Administration
1

biller2 wrote on Wednesday, July 17, 2013:

I am currently using OpenEmr version 4.1.1 with the 12th patch and running ubuntu-maverick with apache 2.2.16 php 5.3.3-1 mysql 5.1.49-1. The problem I am having is with submitting claims to the secondary insurance. I have billed and posted the ERA from the primary insurance company and then created the batch file to send to the secondary insurance company which in this case is Blue Cross Blue Shield of New Mexico. I have also had this same issue with Idaho Medicaid.
Below is a snippet of both batches that rejected as well as the corresponding rejection report. The first snippet is how the EMR posts the ERA it assigns all contractual adjustments with a CASCO45 instead of CASCO223 or the correct corresponding reason code, as I thought changing the reason code to match what the ERA had would allow the claim to go through, but that was not the case.

CAS*CO*45*30.20
CAS*CO*45*0.40
CAS*PR*2*4.96

Error Initiator: HIPAA Message Type: R
Error Code: 0x3938bbe
Error Message: Segment CAS is used. New instance of segment CAS should not be used with the same Adjustment Group Code (CAS01) when previous instance(s) have not-used adjustment trio codes. Segment CAS is defined in the guideline at position 5450.
Version: 5010A1 Loop: 2430
Segment ID: CAS Element #: NA

CAS*CO*45*30.20
CAS*CO*223*0.40
CAS*PR*2*4.96

Error Initiator: HIPAA Message Type: R
Error Code: 0x3938bbe
Error Message: Segment CAS is used. New instance of segment CAS should not be used with the same Adjustment Group Code (CAS01) when previous instance(s) have not-used adjustment trio codes. Segment CAS is defined in the guideline at position 5450.
Version: 5010A1 Loop: 2430
Segment ID: CAS Element #: NA

When I called the insurance company EDI department to have them explain why the batch was rejecting they said the problem is there should only be one “CASCO" line regardless of the reason code. Sure enough If I add up all the adjustments and use "CASCO*30.60” and change/reduce the transaction segment count the claim goes through just fine. I don’t have the TR3 documentation to see how the claim should actually be sent. Any guidance on resolving this issue would be greatly appreciated. Thanks in advance for your help, John

2

kevmccor wrote on Saturday, August 03, 2013:

These segments need to be adjusted:
CASCO4530.20~
CASCO450.40~

to be:
CASCO4530.20**450.40~

and the SE segment needs to have the total segments count reduced by 1,
i.e. SE290065~ becomes SE280065~

You will have to do this in a text editor,

I submitted a patch for this issue but it got no attention (I don’t have time to find it). I am doing other things now and only look here occasionally. Hopefully, I will have time to get back into things, since I continue to be interrested in the project.