Secondary Insurance Causing ERROR

Day-to-Day Users
#1

Hello to all,
There are patient’s who have a secondary insurance that is not handled well by the clearing house. For example; patient’s that have Medicare as primary and Bankers Life as secondary are rejected by Availity. However, if the secondary (Bankers) is deleted then Medicare itself will crossover to Bankers and everything goes well. What is the best method of handling this situation, without deleting the secondary insurance? We have tried the following without success; Deactivate the insurance, Default X12 Partner left Blank and not inputting a CMS ID.
Any ideas?

Thank You,
Henry

#2

hi @hamd, what’s the error from availity?

#3

Hi Stephan,
Thank you for the response.
“Error message: Element SBR05 is missing. It is required when SBR01 is not ‘P’ and payer is Medicare. Segment SBR is defined in the guideline at position 2900.”

Basically Availity doesn’t have Bankers, Colonial Penn and some other insurances in their payers lists. The staff input the patients insurance, as they should, but then the insurance needs to be removed before transmitting, otherwise you get a denial. If you delete the insurance, Medicare will correctly medigap the Bankers. This has been a problem since the beginning.
Regards,
Henry

#4

hi @hamd, change this to match what is in this line

#5

Hi Stephen,
Just to be clear, so line 1007 gets copied to line 1003 right?

Thank you,

Henry

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#6

@stephenwaite
This issue has come up yesterday.

Unfortunately, it did not work.

The secondary insurance is the culprit. If there is no insurance in the secondary insurance position, the claims are accepted just fine.

I called Availity and they said:

Loop 2320 Segment SBR09 is missing completely. (Other subscriber information - claim filing indicator for secondary) Located in the 30th line of data.

There is currently a Loop 2320 SBR02 individual relationship code in secondary - partial information. It is needing the 9th identifier code - claim filing indicator code SBR09) for the secondary policy.

I am looking at this code again.

    ++$edicount;
    $out .= "SBR" .    // Subscriber Information
        "*" . $claim->payerSequence() .
        "*" . ($claim->isSelfOfInsured() ? '18' : '') .
        "*" . $claim->groupNumber() .
        "*" . ($claim->groupNumber() ? '' : $claim->groupName()) . // if groupNumber no groupName
        "*" . $claim->insuredTypeCode() . // applies for secondary medicare
        "*" .
        "*" .
        "*" .
        "*" . $claim->claimType() .
        "~\n";

    // Segment PAT omitted.

I followed the code back to here.

public function insuredTypeCode($ins = 0)
{
    if (strcmp($this->claimType($ins), 'MB') == 0 && $this->payerSequence($ins) != 'P') {
        return $this->payers[$ins]['data']['policy_type'];
    } else {
        return '';
    }
}

I will start my analysis here. Do you have any suggestions?

#7

hi @juggernautsei , what version of OpenEMR are you running?

#8

v7.0.2. No mods. This right out of the box.

#9

We found the possible issue. This line below is the secondary insurance being marked as Medicare and it is not. Now, I need to find where this is in the code and get it to show the write number which in our case should be 17

image

#10

I think we ended up chasing a ghost. I did to change anything in the code. I added a string to the end of each of the lines that produced the SBR*S to identify which was which on the output. Once I did that and then removed them. The correct identifier CI started showing in place of the MB. I was thinking the variable would needed to be cleared. The problem magically went away.

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