singaporejim wrote on Tuesday, February 10, 2009:
Hello,
I’m a newbie to Openemr. I’ve successfully installed Openemr on both a XP Machine as well as one running Ubuntu. So far everything is functioning fine. Does anyone have any instructions or help on submitting claims/batch files/textfiles etc. to Availity?
Thanks,
Jim
markthepharaoh wrote on Saturday, February 21, 2009:
Steps to submit claims to availity for 2.9.1 for Windows XP:
1. Register with availity at www.availity.com, when approved you will receive a user name and password
2. Access the site and go to EDI File Management and select Send and Receive EDI Files
3. Follow the steps shown in the “Show Me Demo”
The X12 information should be completed as follows:
• Select Admin
• Select Practice
• Select X12, complete the info as follows:
1. ID number (ETIN): is the Availity ID that you will get after you register
2. Receiver ID: is the payer listed on Availity website
3. Sender ID: is the ID assigned to you by the insurance company
Good luck, I hope this help!
Mark
singaporejim wrote on Tuesday, March 17, 2009:
Thanks Mark, I’ve got all the required ETIN, Receiver and Sender IDs set up. OpenEmr generates a claim in X12, but they keep getting rejected by Availity for a multitude of reasons.
tmccormi wrote on Tuesday, March 17, 2009:
I think you need to be more specific with what errors you are getting back from them. There are some very cryptic messages that are usually easy fixes to the data once you decode them.
–Tony
markthepharaoh wrote on Friday, March 20, 2009:
Jim /Tony,
I was able to pass step one and two my claim finally got to the insurance company and I had a generic response from them. In order to do that I had to edit the generate X12 file and the billing process file. However, I have to say God bless that hands that programed those files they had availity in there it was just disabled and some codes needed to be changed. I am expecting the final acceptance of the claim today or Monday, as soon as I receive that file I will share the two edited files with detailed explanations of the changes.
Thank you all.
Mark
tmccormi wrote on Friday, March 20, 2009:
If I recall, Rod’s code actually has a note about moving some of that clearinghouse specific configuration into the database setup for the clearing house to make that less hidden. I have been using it (with code changes) quite succesfully.
-Tony
bo2999 wrote on Sunday, March 22, 2009:
Hello,
I, too, need to submit the claims in text file to clearing house. I recently installed the OPENEMR 3.0. and found out that batch claim in text is not supported. I am not a programmer, but after playing with the codes, I finally figured out how to make batch file in text based on HCFA PDF created by Rod. I did not want to mess around with X12 file, therefore I did make some modifications to bill_process.php and bill_report.php in /openemr/interface/billing/ to include text batch mode. Rod has made everything so effortless. Kudo to Rod for his work on billing modules.
Jim, I wonder if you still need it!
Bo,
markthepharaoh wrote on Thursday, March 26, 2009:
Hello everyone,
Here is the code that I changed to be able to submit to availity.
in the "billing_process.php" starting at line 27:
27 // For Availity:
28 $ISA07 = ‘01’; // ZZ = mutually defined, 01 = Duns, etc.
29 $ISA14 = ‘1’; // 1 = Acknowledgment requested, else 0
30 $ISA15 = ‘P’; // T = testing, P = production (P by mark peters) change T to P after passing test
31 $GS02 = ‘AV01101957’;
32 $PER06 = ‘000000’; // Insert your submitter’s EDI Access Number instead of the zeros; 6 digits
// assigned by availity
In the gen_x12_837.inc.php
Near Line 19:
// Max’s coding for different gs02 per availity’s requirement
$newgs02 = “AV01101957”;
Near Line 29 there is some changes as follows
$out .= "ISA" .
"*00" . //
"* " . //
"*00" . //
"* " . //
"*ZZ" . // 5
"*" . $claim->x12gssenderid() .
"*01" . // "*ZZ" . 7
"*" . $claim->x12gsreceiverid() .
"*030911" . // TODO: Y-m-d H:i
"*1630" .
"*U" .
"*00401" .
"*000000001" .
"*1" . // "*0" . 14
"*P" .
"*:" .
"~\n";
I hope this help.
Mark
markthepharaoh wrote on Thursday, March 26, 2009:
Inside the program under X12 Partner:
ID number (ETIN): (number assigned to you by availity 6 digits)
Receiver ID: 030240928
Sender ID: AV09311993
Hope this help
uhsarp wrote on Wednesday, August 10, 2011:
sorry for resurrecting a very old post!
#markthepharaoh, I used your second code snippet (as the first seems to be implemented in the 4.0 within Partners page). But I still keep getting these errors.
ISA02 It should be 10 blank spaces instead of 1
ISA04 should also be 10 blank space istead of 1
ISA12 should be 00401 instead of 0040110809
ISA13 control number should be 9 digits instead of 2006
18 positions in ISA segment coming through. 14th position should've been ISA11, 15 should be ISA12,16 should be ISA13. everything is moved
over a couple of spaces.
there are more than 16 segments in the ISA (should be taken care of once the extra spaces are fixed)