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OpenEMR with Availity

Is anyone successfully using OpenEMR to submit claims through Availity. I’m using OpenEMR v5.0.1 (7) but all claims are rejected. My payer is BCBSTX (Blue Cross Blue Shield of Texas).

The X12 file generated by OpenEMR results in the following rejection message from Availity.

Reject Message:
Unrecognized data was found in the data file as part of Loop 2000B. The last kno
wn Segment was HL at guideline position 0010.

Reject Message:
Unrecognized data was found in the data file as part of Loop 2010BB. The last kn
own Segment was NM1 at guideline position 0150.

I can fix all of the X12 formatting errors generated by OpenEMR with “EDI Notepad” but other processing errors will follow.

At envelope ZZ/AV09311993->01/030240928, Ctrl=026860807
At group AV01101957->030240928, Ctrl=1
At message 837:0123 Ctrl=0001
In segment B.HL.SBR
Mandatory element missing for segment ‘SBR’ at position 1
In segment B.HL.NM1.NM1
If one is present, then all must be: NM108, NM109
In segment B.HL.NM1.NM1
If one is present, then all must be: NM108, NM109
In segment B.HL.NM1.N3
Mandatory element missing for segment ‘N3’ at position 1

Are there any other clearing houses that accept OpenEMR X12 files without customization? Maybe OfficeAlly?

Thanks in advance.

hi @DONMNELL, should be able to use any x12 partner, can you paste the 837 file with the phi redacted?

Hi Stephen,

Here is the file.

Thank you.

ISA*00*          *00*          *ZZ*AV09311993     *01*030240928      *210126*0906*^*00501*026860807*0*P*:~GS*HC*AV01101957*030240928*20210126*0906*1*X*005010X222A1~ST*837*0001*005010X222A1~BHT*0019*00*0123*20210126*0906*CH~NM1*41*2*ABC MEDICAL GROUP*****46*471990379~PER*IC**TE*2105551212*EM*DRABCABCMEDICALGROUP.COM~NM1*40*2*AVAILITY*****46*030240928~HL*1**20*1~NM1*85*2*ABC MEDICAL GROUP*****XX*1114323466~N3*123 MAIN STREET~N4*AMITYVILLE*FL*111119999~REF*EI*471990379~HL*2*1*22*1~SBR~NM1*IL*1******MI~NM1*PR*2******PI~N3~N4~HL*3*2*23*0~PAT~NM1*QC*1*DOE*JANE~N3*456 MINOR STREET~N4*AMITYVILLE*FL*111119999~DMG*D8*19840404*F~CLM*1091-25401*255.00***11:B:1*Y*A*N*Y~HI*ABK:F411*ABF:F340~NM1*82*1*SMITH*MARY****XX*1518285840~PRV*PE*PXC*207Q00000X~LX*1~SV1*HC:99214*135.00*UN*1***1~DTP*472*D8*20210104~LX*2~SV1*HC:90836*120.00*UN*1***2~DTP*472*D8*20210104~SE*33*0001~GE*1*1~IEA*1*026860807~

thank you @DONMNELL, you’ve got to enter the insurance and subscriber information

Thank you. I will double check that when able and report back. Thanks again.

IT WORKED !!!

After following your suggestion to add the missing insurance information, I only had one remaining error.

OpenEMR was striping the ‘@’ from the email address in the data following EM*. Added the missing ‘@’ manually and the claim went through.

Not sure why OpenEMR strips that out.

Thanks for your help.

1 Like

must be a bug in that old version, rec upgrading to 6.0.0 if possible, hand editing 837s is only fun when just starting out :slight_smile: