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?
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~
We are having issues with submitting claims to Availity as well. We can’t get claims to process. Our IT vendor spoke to Availity and indicated the following:
“When I talked to the Availity Cust Svc she identified an issue that indicates that the x12 claim file generator appears to be building the claim file in a format Availity doesn’t recognize: it put the X12 Partner identifiers where the Receiver identifiers should be. I believe that the default claim file generator code that OpenEMR comes with formats it for a different clearinghouse. Since all the claim files it generates would have that same incompatible formatting I haven’t sent the other claims- they’d all get rejected for the same reason.
I’m checking with our developers to see if that’s the case. If it is, they’ll need to rearrange the generator’s code to output it in the format Availity wants.”
Is this an issue others have had or a known issue? Would love to get Availity working!
We are using Version Number: v6.1.0-dev of OpenEMR.
It’s loop 1000B, the receiver information. The part of the file that includes it is: ISA*00* *00* *ZZ*AV09311993 *01*030240928 *210928*2012*^*00501*632874329*1*P*:~ GS*HC*5010*030240928*20210928*2012*1*X*005010X222A1~ ST*837*0001*005010X222A1~ BHT*0019*00*6328743290001*20210928*2012*CH~ NM1*41*2*NEW LEAF BEHAVIORAL HEALTH*****46*320204218~ PER*IC*ATTN OFFICE MANAGER*TE*9197818370*EM*[INFO@NLBH.ORG](mailto:INFO@NLBH.ORG)~ NM1*40*2*AVAILITY*****46~ HL*1**20*1~ PRV*BI*PXC*251S00000X~
The message that this was a HIPAA error:
‘Missing element NM109’
As explained by the CS person the receiver should be BCBS not Availity.
I looked in the forum and didn’t find anything recent about loop 1000B. In the posts I found the code changes they suggested were incorporated into the codebase in OpenEMR 4.
Hi @stephenwaite - as it happens, I’m the ‘IT Vendor’ and I’ve tried generating the claim with ‘Generate X-12 Based on Insurance Company’ both on and off. The files produced are identical.
And I have been manually uploading individual claims through the Availity website for now, until the claims are regularly accepted. Then will start ftp’ing batches.
As Dava reported, the Availity CS tech says that line, NM1*40*2*AVAILITY*****46~
should be the BCBS identifier instead of Availity (with one more datum at the end in position 09). I mean, unless I mis-identified loop 1000B?
I would think the info came from the insurance and theirs is complete-- unless of course it wants the ‘Payer ID for Encounter Claims’, not the other one? But I wouldn’t think that would make it put the wrong line in there.
usually the clearinghouse replaces their information in the 1000B in the submitted 837, presumably they move that into the 1000A loop and the insurance into the 1000B when they push to the payer
