Rendering provider and referring provider switched

Day-to-Day Users
#1

We’ve been told when billing Medicaid beginning on our April 2018 files, that our NPI numbers are populating the referring provider (box 17) rather than the rendering provider (box 24J). We use an import and have not changed anything in our set up. I see no reason that this should happen, and see no way to change it in the system. Anyone have help on this?

#2

Hi @lmcvay, is this on the 837 electronic X12 files?

#3

Stephen, yes it’s an 837P. We just started having the issue with April 2018 billings. We are using OpenEMR v4.1.0.

#4

Ok, thanks for the extra info so your Medicaid contractor changed the way they process the 837. Do you have access to those specs? Or you could provide your state and I could try to find them.

#5

I’m in Washington state, I’ve requested the specs from Medicaid. I will send when I get them. Thanks.

#6

The documents are here: https://www.hca.wa.gov/billers-providers/prior-authorization-claims-and-billing/hipaa-electronic-data-interchange-edi

#7

ok, thanks @lmcvay, have you thought about upgrading to the latest version of OpenEMR?

#8

Hi @stephenwaite I think it would prove useful to move MBO to claims. I don’t have time now but you could look at :slight_smile:

#9

Do you think that’s the problem? We have limited support for the application in our IT department, no real experts and they are hesitant to upgrade. If that’s the fix then I’ll have to relay back to them.

#10

Nope, this would be feature upgrade for future release. I was just looking for reason to bring it up…

#11

ok @sjpadgett, will take a look, @lmcvay thanks for the docs, i’m not seeing any recent revisions

Could you go into the edi history module, Fees->Edi History, and find a medicaid claim from march and one from april, preferrably the same person, strip the phi and upload it so we can see what gives? thanks

#12

Yes, I’ll get that from our biller tomorrow. Thanks for the help.

#13

nice, my plesure, do you submit directly to Medicaid or do you use a clearinghouse?

#14

We submit directly through a file upload to Medicaid.

#15

Are you wanting me to strip it and upload to this post? Or to Medicaid? I don’t see fees>edi, but I do have a client to test.

#16

hi @lmcvay, posting it here, your biller would have access to the x12 837 that have been generated in OpenEMR under Fees->EDI History.

#17

Date of Service: 3/5/18

ISA*00* *00* *ZZ*100831600 *ZZ*77045 *180515*1912*^*00501*025440612*1*P*:~
GS*HC*100831600*77045*20180515*1912*1*X*005010X222A1~
ST*837*0001*005010X222A1~
BHT*0019*00*0123*20180515*1912*CH~NM1*41*2*TPCHD MSSICM*****46*100831600~
PER*IC*LISA MCVAY*TE*2537986422*EM*lmcvay@tpchd.org~
NM1*40*2*WA STATE DSHS*****46*77405~
HL*1**20*1~
PRV*BI*PXC*171M00000X~
NM1*85*2*TPCHD MSSICM*****XX*1346379427~
N3*3629 SOUTH "D" STREET~
N4*TACOMA*WA*984186813~
REF*EI*911488160~
HL*2*1*22*0~
SBR*P*18*******MC~
NM1*IL*1*XXXX*XXXX****MI*999999999WA~
N3*4719 MCKINLEY AVE D~
N4*TACOMA*WA*98404~
DMG*D8*XXXXXXXX*F~
NM1*PR*2*WA STATE DSHS*****PI*77045~
N3*CLAIMS PROCESSING*PO BOX 9248~
N4*OLYMPIA*WA*98504~
CLM*10363-3737*70.00***12:B:1*Y*A*Y*Y~
HI*BK:Z331~
NM1*DN*1*SU*LANI****XX*1437687860~
LX*1~
SV1*HC:T1002:HD:TF*35.00*UN*1***1~
DTP*472*D8*20180305~
LX*2~
SV1*HC:T1002:HD*35.00*UN*1~
DTP*472*D8*20180305~
SE*30*0001~
GE*1*1~
IEA*1*025440612~

Date of Service 4/11/18
ISA00 00 ZZ100831600 ZZ77045 1805151915*^005010254406161P*:~GSHC100831600770452018051519151X005010X222A1~ST8370001005010X222A1~BHT0019000123201805151915CH~NM1412TPCHD MSSICM46100831600 ~PERICLISA MCVAYTE2537986422EMlmcvay@tpchd.org~NM1402WA STATE DSHS4677405~HL1201~PRVBIPXC171M00000X~NM1852TPCHD MSSICM***XX1346379427~N33629 SOUTH “D” STREET~N4TACOMAWA984186813~REFEI911488160~HL21220~SBRP18MC~NM1IL1XXXXXXXXMI999999999WA~N34719 MCKINLEY AVE D~N4TACOMAWA98404~DMGD8XXXXXXXF~NM1PR2WA STATE DSHSPI77045~N3CLAIMS PROCESSINGPO BOX 9248~N4OLYMPIAWA98504~CLM10363-380935.0012:B:1YAYY~HIBK:Z331~NM1DN1SULANIXX1437687860~LX1~SV1HC:T1002:HD:TF35.00UN11~DTP472D820180411~SE270001~GE11~IEA1*025440616~

#18

thanks for posting @lmcvay, the BK below should be ABK

so it looks like you need this patch

you probably should just edit the file and change BK to ABK and BF to ABF

#19

That doesn’t help us with the rendering vs. referring provider issue. Were you able to find out anything about that?

#20

I thought it might be affecting that segment too.

This is the referring provider segment:
NM1*DN*1*SU*LANI****XX*1437687860~
there is no rendering provider segment in these uploads