tsvas wrote on Sunday, March 27, 2011:
Can someone help me how to use “Report - Eligibility 270 Inquiry Batch”. I guess it automatically pulls insurance eligibility. When I used my clearing house as X12 partner, it is giving error in red “* Clearing house info required for EDI 270 batch creation”.
visolveemr wrote on Monday, March 28, 2011:
Hi,
“* Clearing house info required for EDI 270 batch creation” is just a warning, you can ignore it.
Refer the following link for workflow document:
http://sourceforge.net/tracker/?func=detail&aid=3019716&group_id=60081&atid=1245239
Thanks
ViCarePlus Team,
www.vicareplus.com
services@vicareplus.com
tsvas wrote on Monday, March 28, 2011:
Hello, thanks for info. As Brady wrote in other thread:
1) Made a new patient
2) Made a new insurance company
3) Made and X12 Partner
4) Added insurance to the patients’s primary
5) Made an appt for today
6) Went to the report and put date from (anything basically) and to today
6) Hit refresh and the patient showed up
7) Then choose an X12 Partner and click ‘Create Batch’ and it send a text file via x12 stuff
I am using Availity. First 2 times I missed ISA06 and GS02, so results failed. Third time onwards, I am the following error from Availity:
Interchange Note: Duplicate Interchange Control Number
When I spoke to Availity, they said that they are getting duplicate control number…
Please advise.
tsvas wrote on Monday, March 28, 2011:
Looks like there are some programming issues with Eligibility:
1. Control number sequence increment
2. Selected Receiver ID Qualifier (ISA07) as Duns, but it generates file content as ZZ (instead of 01).
3. Application Sender Code (GS02): Some how it is picking the value from Receiver ID (ISA08).
Availity guidelines are in page 29 of http://www.availity.com/documents/edi_guide.pdf.
Can someone fix it. Thanks!
tsvas wrote on Tuesday, March 29, 2011:
Can anyone confirm that there is an issue with eligibility module, or am I doing something wrong…
tmccormi wrote on Tuesday, March 29, 2011:
The code was contributed by MMF Systems, not sure if they are monitoring the list closely. You could send the a email, they are listed on the ‘Commercial Support’ page at http://wiki.oemr.org/wiki/OpenEMR_Commercial_Help
-Tony
tsvas wrote on Tuesday, March 29, 2011:
Thanks Tony. I sent them an email.
mmfsystems wrote on Wednesday, March 30, 2011:
Hello All,
Apologies for the delay in response. I am looking at the issue and will get back to you ASAP.
Thanks,
Vineet
MMF Systems
aethelwulffe wrote on Thursday, March 31, 2011:
If you need a troubleshooter/tester for any of this, lemme know. I am interested in using this module, and I wanna help get it working if I can.
What I am currently experiencing in a Mar22 version of 4.0 (soon to be updated to the latest release):
1. Report lists only patients that have had appointments in the calender. I see the sense in this, so you can check eligibility of up-coming patients, but not all our clients are scheduled in the emr…most in fact are never on the calender. It would be nice to check eligibility across the board.
2. Selecting an x-12 partner does not restrict the list to just the insurance companies using that x12 partner. Also, with no check boxes/radio buttons, you must “delete” each item in the list individually to edit them from the generated list.
3. Provider for the eligibility check seems to be from the calender as well. I see the sense in this and understand it’s use, but I inquire as to if there is some way of simply checking for eligibility against the facility npi instead of against a particular billing provider, as the provider on the calender might very well not actually be the billing provider.
tsvas wrote on Tuesday, April 12, 2011:
Vineet/aethelwulffe, just wanted know if you have a chance to fix the issue, and ready for production.
mmfsystems wrote on Wednesday, April 13, 2011:
Hello All,
I have fixed the issue and committed the fix to the git repository.
Please see the link .
Please check the fix and let me know for further assistance.
aethelwulffe, Please test/review the functionality and let me know for further assistance.
Thanks,
Vineet
MMF Systems
bradymiller wrote on Thursday, April 14, 2011:
Hi,
Placed a review of this code on github.
thanks,
-brady
paanii13 wrote on Thursday, April 14, 2011:
Hi Vineet/aethelwulffe,
I submitted a eligibility request to Availity(using your fixed code) and received the same error. Below are my x12 settings
X12 PARTNER: AVAILITY
ID: “EIN”
RECEIVER ID QUALIFIER (ISA07):Duns (Dun & Bradstreet)
RECEIVER ID (ISA08):030240928
SENDER ID QULAIFER(ISA05):Mutually Defined
SENDER ID(ISA06): AV09311993
ISA14:Yes
SUBMITTER EDI ACCESS NUMBER(PER06):V07432
VERSION:004010X098A1
PROCESSING FORMAT: standard
Am I missing anything?
Has anyone successfully submitted an eligibility request to Availity?
aethelwulffe wrote on Saturday, April 16, 2011:
I will test tomorrow evening Vineet. I am doing a total system backup tomorrow night anyway, and I can play hardball with the “real files” without spending a lot of time. Thanks for the code dude!
aethelwulffe wrote on Saturday, April 16, 2011:
AVAILITY TA1 INTERCHANGE ACKNOWLEDGEMENT
Customer ID: 0023558 File Status: REJECTED
Date Received: 2011-04-16 Time Received: 15:20:14.435
Filename: elig-270…2011-02-01.2011-04-16.txt
File Control Number: 895446777
********************************************************************************
Interchange acknowledged: TA101
********************************************************************************
Interchange Date: 110416 Interchange Time: 1514
Interchange Status: The Transmitted Interchange Control Structure Header and Trailer are Rejected Because of Errors.
Interchange Note: Unknown Interchange Receiver ID
Their system will be down from 16apr 1700- tomorrow. I will call them and find out what the heck, but I think this here is a good hint as to what is screwy:
ISA*00*0000000 *00*0000000000*ZZ*AV09311993 *01*AV09311993 *110416*1514*U*00401*895446777*1*P*:~GS*HS*AV01101957*030240928
Lots of zeros……Not good. should be blank spaces.
BTW, ISA01-04 ARE used by some companies, and should be configurable in OpenEMR. I have modified files for claims and x12 partner configuration here: http://starfrontiers.org/khvcode/Openemr/x12_header_mod.zip
Part of these files include a new edit html that allows you to configure your x12 partner data with the elements in ORDER, instead of the mis-matched mish-mash order they are currently in, as well as allowing configuration of the whole header. To finish this, not only do we need to sql queryies to have patch updates, but also have the 4.1 upgrade added as well (prolly the 3.2 upgrade also). If we have the 270 using these new x12 partner variables, we will have a complete system.
Can I convince you of something here? 
Perhaps you could utilize my files to make changes here, and allow these values to have configurable settings. Without such, I won’t (and a lot of folks in Fl &IL won’t) be able to use it for everyone. Once this is done, I believe a lot of recurring issues will be solved. You could integrate my includes, use those fields/variables the way I have done in my x12 gen changes, and we could be trottin hot.
aethelwulffe wrote on Saturday, April 16, 2011:
paanii,
Here are the availity settings I use, though the display you see is with my modified code:
mmfsystems wrote on Tuesday, April 19, 2011:
Hello aethelwulffe,
Thanks for your help.
As per the standard, the Zeors in the interchange header segment are valid if no information is present for that data element (e.g. ISA01-04).
As per your suggestion we can make it configurable.
I have seen an interchange note in the “AVAILITY TA1 INTERCHANGE ACKNOWLEDGEMENT Report” like below:-
Interchange Note: Unknown Interchange Receiver ID
that may be another cause of error.
Can you please confirm that whether the error is due to the header segment information OR any other issue?
Thanks,
Vineet
MMF Systems
aethelwulffe wrote on Tuesday, April 19, 2011:
I should have called availity yesterday to confirm the error.
The receiver was medicaid.
Have you successfully tested output?
mmfsystems wrote on Wednesday, April 20, 2011:
Hello,
Yes i have successfully tested the output file with Zirmed.
Thanks,
Vineet
MMF Systems
paanii13 wrote on Sunday, May 01, 2011:
Hello aethelwulffe,
Thanks for the print screen. It help me resolve the ISA Errors. Now I am getting GS Errors. Below are my default settings
GS01 (Functional ID Code):HS
GS02 (Sender Identifier):AV09311993
GS03 (Receiver Identifier):030240928
GS08 (Version): 004010X092A1
GS04 (Date):CCYYMMDD
GS05 (Time):HHMMSS
GS06 (EDI Group Control Number):000000002
While reviewing the Availity EDI Guide I realized that there is no GE segment in the batch generated by openemr.
Have you successfully submitted an eligibility batch to Availity? If the answer is yes , would you please share your modified x12 Partner form or if its for sale, can you please email me your price. my email is paanii13@gmail.com.
Thanks