Patch 4 installed and now Florida Blue Claims are being rejected

Support
#1

Situation
Florida Blue Rejecting claims for “Invalid PayerID”

OpenEMR Version
5.0.2(4)

Browser:
I’m using: FF 82.0

Operating System
I’m using: Ubuntu 20.04

Logs
Did you check the logs? Was there anything pertinent in them? Paste them here (surround with three backticks (```) for readability Nothing pertinent in the logs.

Here we go again with the never ending issue with Florida Blue insisting on us putting their “payerID” in Loop 1000A of the X12 file in place of the industry standard Billing Facility ETIN. We’ve had this hard coded in the “gen_x12_837i.inc.php” since 2012. This code immediately follows the “46”; at the end of the BillingFacilityName Section:

“*” . “46”;

     if (trim($claim->x12gsreceiverid()) == '470819582 ') { // if ECLAIMS EDI
$out .= "*" . $claim->clearingHouseETIN();

} else if ($claim->payerID()==‘00590’) {
$out .= “" . “G07IL”;
} else {
$out .= "” . $claim->billingFacilityETIN();
}
$out .= “~\n”;
++$edicount;

For some unknown reason, after the application of patch 4 the code no longer performs the function of replacing the ETIN when the payerID on the claim is Florida Blue (00590). The code is still in the gen_x12_837i.php file, it just doesn’t work anymore. Seems we’ve just taken a giant step backwards.

Anyone willing to share their thoughts on this?

#2

Hi @hitechelp , try this file

#3

Stephen,
Does this file need to be renamed to “gen_x12_837i.inc.php” or loaded as is?
“As is” would explain why nothing I did to the gen_x12_837i.inc.php file had any effect.
Am I to assume that it belongs in the openemr/library folder?

Regards,
David

#4

hi @hitechelp, billing was reorganized a couple of years ago, name change and file location for the script

#5

Well done Stephen!
Cudo’s to Jerry for all his efforts in reworking the billing section for Patch 4.
We’re in the money once again.
Thanks guys!
David

2 Likes
#6

David you may want to note this PR as if you use EOB invoice, there’s a gotcha!