Tracking payments, EDI etc

Day-to-Day Users
#1

Windows 11
openEmr 7.0.2

Hello -

I am deeply indebted to the experts here who have helped me get set up with 7.0.2, and enter my various codes. It’s all working now, and I am hopeful it will continue to work!

Next issue: my client is currently being paid by check by the insurance companies, and as a consequence doesn’t have a clear picture of whether things are being paid properly, or at all.

A while ago someone on this site told me that using openEMR I should be able to track payments, use EDI, etc. Can someone outline for me what I need to do to get that set up? I am currently submitting X12 through “Post’N’Track”, which handles the following insurances:

Aetna PPO, Cigna Health Plan, Emblem Health HIP, GHI, Oxford Health Plan, The Empire Plan and United Health Care

(Strangely it doesn’t handle Blue Cross Blue Shield though - if anyone has a (free?) alternative to Post’N’Track that does, please let me know.)

Anyway, years ago we attempted to connect with a few of these in a way where we get paid electronically, though somehow that never got accomplished. I guess doing that would be the first step?

And once that’s done - how do I interface with OpenEMR to track the payments, EDI, etc? Is that easy/doable?

Thanks

Leon

#2

hi @leongruenbaum , my company offers professional support for OpenEMR medical billing and would be glad to assist you.

#3

Hello @leongruenbaum
If you would like to give the old DIY a try, the OpenEMR wiki has some tutorials on the basic billing workflows, including registering patient payments by checks.
You need to set up your OpenEMR’s insurance and x12 partner settings as found in
https://www.open-emr.org/wiki/index.php/OpenEMR_7_Practice_Settings

and carry out the workflows as described in
https://www.open-emr.org/wiki/index.php/OpenEMR_6.x_Billing_-_Claims_Workflows

and
https://www.open-emr.org/wiki/index.php/OpenEMR_6.x_Billing_-_Process_Payments

However, even though it can be done, connecting with a clearinghouse to process your billing electronically is much less of a DIY endeavor. Even after setting things up so you can generate x12 claim files every clearinghouse has peculiarities in their claim file requirements which makes having access to the expertise of a billing company such as @stephenwaite offers, a sincere time/ money saver.
Good luck in your endeavor!
-HT

#4

Thanks for the links

Yeah - just to make clear our current situation

First of all, this is a one person shop- well, two including me :). I can follow up with Stephen, but hiring him may be out of our reach, financially

We do have insurance and the x12 partner stuff set up, and it seems to me we are now at the point with the new system that it should at least be able to send the x12 files into post’n’track as it used to

But we never were able to tell easily what got paid etc

We did once start the process of getting paid electronically by these companies, and I got the impression each insurance company has a different system. And even trying to get one set up proved so complicated we just gave up at some point(!)

Anyway let me see how far I can get

Thanks again , guys

#5

Just glancing at the PNT site (Enroll) they appear to be a clearinghouse, right? Sorry if you know all this already but the clearinghouse is the middle-man between you and the insurance companies: you send PNT your claim files and they reformat them to suit all the different insurance companies’ complications and requirements, then send you the payments returned by the insurance companies. The site looks like their implementation team should be able to help you if you don’t have that all the way working yet.

As far as telling what’s been paid etc, if PNT doesn’t give you reports, have you looked in the financial reports OpenEMR has? If you’ve been generating the claims properly and entering into OpenEMR the electronic payments PNT sends back, you should be able to locate what has and hasn’t been paid and a lot of other good info.

image

Sorry I don’t have any data to show what the reports look like.

Best- Harley

#6

Thanks, Harley

Yes- we have it working as far as sending the x12 files to PNT- this has been working with our old version of openemr for a while

Once we send to PNT then as far as I know the insurance companies send the checks directly to my client. (Pretty sure she’s not receiving checks from PNT)

But because they are currently sending paper checks and because client hasn’t been organized about inputting payment info back into openemr, we don’t really know for sure she’s getting paid for everything properly

So it’s my hope that if we can get paid electronically then there should be a relatively easy way to bring that payment info into openemr so we can see that each claims was paid

is it the EDI data we’d read into openemr? I have to admit I haven’t investigated what exactly EDI is, just seemed to be the data that would tell us about the payments

Thanks

Leon

#7

hi @leongruenbaum , you have to sign up for ERA (electronic remittance advice) with the insurance companies who will route it to your clearinghouse where it can then be posted against the claims.

1 Like
#8

Ah, the Word from the Pro; thanks @stephenwaite

EDI means ‘Electronic Data Interchange’ which is simply sending info electronically instead of on paper. The ‘ERA’ Stephen mentioned is the EDI file that contains the payment information. When those are processed into OpenEMR per the process described in the above-linked page ’ OpenEMR 6.x Billing - Process Payments’, that data is kept and is available to the EMR’s reports and tracking tools.

So, if the customer is getting paper checks from the insurance companies none of the paper checks or their payment itemizations will have been entered into OpenEMR. A manual payment posting procedure does exist that takes the information from paper checks and statements but it doesn’t track payments for individual procedures.

It’s sounding like your customer’s billing arrangements need some investigation and adjustment.

Best- Harley

#9

Thanks

Btw @stephenwaite - I’d be more than happy to hire your company, but I’m really not sure whether the client wise able to spend money on this. Anyway I’ll check with her

It sounds like the first step is to get paid electronically from each insurance company, and once that’s done hopefully I can import the ERA files to openEMR and then see that she’s getting paid.

Anyway, assuming I have that right let me see how I do , and hopefully I won’t need to bug you guys any more. Really appreciate the help to this point- a real lifesaver!

Leon

#10

I know you want free for a clearinghouse, and while my service isn’t free, i can help you get your claims and track those claims to and from the payer.

Anyway, if you get tired of going at it alone, my site is www.claimrev.com

#11

you can with some insurances still get paid by check but get the electronic remittances but not with UHC for instance

#12

Ok thanks. Good to know