Pain clinic needs facility CLIA number to populate Box23


(Sherwin Gaddis) #1

The clinic is a pain management facility and they need the CLIA number that is under the facilities to populate box 23 all the time. The number never changes and it not per patient.

How can we do that?

(Stephen Waite) #2

for 5.0.0 hcfas see openemr/ at rel-500 · openemr/openemr · GitHub

and change priorAuth to cliaCode

(Sherwin Gaddis) #3

Is that the only place that needs changing for Box 23?

@stephenwaite can we make this a feature. I was thinking for doing a PR where in the globals under billing there is a check box about what goes in box 23. Unchecked prior Auth goes in box 23 and checked CLIA goes in box 23. Default will be unchecked.

Your thoughts please.

(Stephen Waite) #4

are they sending electronic claims?

(Sherwin Gaddis) #5

Yes, they are.

(Stephen Waite) #6

removing the && condition will hard code for every claim

edit: ignore above on my fork, from openemr looks good to go

(Sherwin Gaddis) #7

Thanks, @stephenwaite. I will have the biller test it out and update us with the results.

(Sherwin Gaddis) #8

@stephenwaite have you included this feature in the code base?

(Stephen Waite) #9

hi @juggernautsei, no, needs more analysis, here’s CMS guidance for item 23 on hcfa:

  • Enter the Quality Improvement Organization (QIO) prior authorization number
    for those procedures requiring QIO prior approval.
  • Enter the Investigational Device Exemption (IDE) number when an investigational
    device is used in an FDA-approved clinical trial. Post Market Approval number should
    also be placed here when applicable.
  • For physicians performing care plan oversight services, enter the NPI of the home health
    agency (HHA) or hospice when CPT code G0181 (HH) or G0182 (Hospice) is billed.
  • Enter the 10-digit Clinical Laboratory Improvement Act (CLIA) certification number for
    laboratory services billed by an entity performing CLIA covered procedures.
  • For ambulance claims, enter the ZIP code of the loaded ambulance trip’s point-of-pickup.
    NOTE: Item 23 can contain only one condition. Any additional conditions should be
    reported on a separate CMS-1500 claim form.

haven’t looked at 837 yet

(Sherwin Gaddis) #10

So I see that this is not a one size fits all situations. CMS has different things for different situations for box 23.

(Stephen Waite) #11

we could start with your case and then leave some todos in the comments as has been done with other scenarios

(Sherwin Gaddis) #12

Sound great!