Trizetto and openEMR

Day-to-Day Users
#1

medfetch wrote on Tuesday, June 23, 2015:

I have been trying to use openEMR with Trizetto as a clearinghouse. Thank you for those that provided insight and their working Trizetto recipes. I wanted to share that it has been three weeks and I am set to go with the payers, but Trizetto/gateway EDI is unable to validate my X12 files.

Today they informed me: “We have decided for Open EMR since it is Free on the web and offers no support that all sites will need to send a test file and it would be tested through our vendor test team. It would be treated like every site is a new vendor.” I explained that there is support and we are following their instructions but we needed to know what was wrong with the headers. “No I am sorry I cannot because your files will not run through our test system so I cannot tell what is missing in the files.”

We received two different companion documents with different ReceiverIDs, one requesting we use 4010 format and another 5010. When we asked what values should go in which ISA fields, they had no idea. Perhaps the vendor team knows X12 terms? I’ll try to talk to them today and will provide an update if I have success.

Can anyone comment about any benefits Trizetto/Gateway EDI has that I should continue to beat down this door before abandoning them?
Thanks
Ray

#2

fsgl wrote on Tuesday, June 23, 2015:

Is there a particular reason to use Trizetto?

Would you be interested in another suggestion?

#3

teryhill wrote on Tuesday, June 23, 2015:

Our customers use Trizetto. If you want to send me a test file I can look at it and see if anything jumps out at me. It has been my experience that each clearing house has there own set of rules so trying another may be the best Idea.

terry@lillysystems.com

Terry

#4

sunsetsystems wrote on Tuesday, June 23, 2015:

In my experience it’s normal for clearinghouse setup to include a round of testing. Just be careful with PHI, don’t go posting patient claim data here or sending it to a vendor without a HIPAA BAA in place.

Rod
http://www.sunsetsystems.com/

#5

teryhill wrote on Tuesday, June 23, 2015:

Yes make sure it is test data IE patient Mickey Mouse

#6

fsgl wrote on Tuesday, June 23, 2015:

The first big hurdle is setting up X12 Partners. If the clearinghouse is loath to help in that regard, it will be an uphill struggle.

Our local Blue Shield decided not to participate with Office Ally, which necessitated sending claims to their own clearinghouse. It was like pulling teeth.

The companion manuals needed updating. No one thought that I should be informed. It took 2 months from the time I sent in the enrollment forms to the time that I was able to send production files.

Office Ally via LogMeIn set up X12 Partners for us. Our office was sending claims in less than 24 hours. No fooling around with test files, ST/SE segments, etc., etc., etc.

The contrast was like night & day.

#7

medfetch wrote on Tuesday, June 23, 2015:

I finally got to someone who understands X12. Turns out the batch was not being terminated with a tilde. 3 weeks later. Very frustrating. My previous payor IDs (I used Zirmed but in the same state) did not match, but Trizetto has the “correct” ones listed on their website. My claims will go out tonight. :slight_smile:

Reason for Trizetto is that I joined a “Group” - we are separate corps sharing overhead. All ophthalmology. They are switching out of Origin/Meridian PM. The Group is leaning towards NextTech (PM only not EMR) who uses Trizetto. They said if I can show openEMR is capable of doing what they need on the PM side they would use it, but by using Trizetto on the backend will make the transition easier if they choose NextTech in the end. This would also give them another way to evaluate Trizetto as a backend over the next 6 months as we will be bringing billing back in house either way.

Is the tilde a known bug that my version is missing or is this a Trizetto specific issue?

#8

fsgl wrote on Tuesday, June 23, 2015:

Checked our last 4 837P’s, no ~ problem there nor in the past 4 years.

This is a known bug.

Good references, if unknown to you, 1 & 2.

1 is for 4010, but with plenty of detail. 2 is for 5010, but rather skimpy.

#9

htuckjr wrote on Wednesday, June 24, 2015:

Hello Ray-
I’m happy for you that you’ve found an x12 guru and you’re looking forward to your claims going out. I know the feeling, having learned by similar hard knocks how to get our OpenEMR customers’ claims through Trizetto. Getting them accepted for processing is the first step; the next is beating the amazingly opaque error messages. If you run into any that throw you I’d be glad to offer an educated opinion on them.

OpenEMR is completely capable of creating claims that are successfully processed by Trizetto but I guess one must pay one’s dues. I’ve never used a different clearinghouse than Trizetto so I have nothing to compare it to but fsgl’s tale of remote setup and 24 hr productivity with Office Ally is pretty amazing.

Good luck!
Harley Tuck

#10

htuckjr wrote on Wednesday, June 24, 2015:

Thank you, fsgl, for that wonderful resource about the 5010 x12 segments and loops. Wish I’d had that 6 months ago, and it’s going to come in REAL handy now.
Rgds- Harley

#11

fsgl wrote on Wednesday, June 24, 2015:

Hi Harley,

The Internet is a treasure trove. The Wiki has become robust.

Without the Wiki & online articles I would be reduced to sending paper to Blue Shield now.

#12

medfetch wrote on Wednesday, June 24, 2015:

Thank you Harley for your recipe. It made all the difference. Now to find out why I am missing the trailing ~ and I noticed my batch files start with a carriage return. This should break a sensitive X12 reader too. I suspect the latter is an apache2 issue.

#13

medfetch wrote on Wednesday, June 24, 2015:

As I delve into this, when I open a batch file on the server in a terminal session using pico/nano eg. openemr/sites/default/edi/2015-06-24-1006-batch.txt, it has no extra new line at the top and the tilde is present as the last character. So it is being created correctly. When I view it directly via the browser, the file is correct too. However when I download the file, it has these changes… So it is not an openEMR issue really, but is a site configuration issue. Looking closer at apache2 and the download process…

#14

medfetch wrote on Wednesday, June 24, 2015:

OK. Appears all the newline and tilde are fixed - I’m not sure why but my library/gen_hcfa_1500.inc.php had a blank line before the opening <?php tag. Removed and that got rid of the extra line. Seems any characters added to the top, subtracts characters from the bottom of the batch file??? Not sure why because I didn’t get so immersed in the X12 generation code but I noticed this during debugging. By removing the space/line, the newline disappeared in the batchfile on download, and the tilde showed back up at the bottom.