ideaman911 wrote on Wednesday, February 11, 2009:
According to UHC, the 2.9.1 dev distribution has some problems with UHC X12 submittals, and I was getting rejects on almost all. Since I am certain very few of us can look at an X12 and know instinctively what the fail codes mean, I went through each failure noted and addressed them with the UHC specific x12_receiver_id, so as to leave the remainder logic exactly as it was. See also my note on the "Onset = Zero" in encounter.
Revise from near line 206 in …/library/gen_x12_837.inc.php to resolve H20204 & H40113 errors for child of subscriber for UHC X12 billing to place Null instead of code 19 per normal X12, also fix H24391 PAT*19~NM1.
$PatientHL = 0; // Value was 0 causes HL Loop Children Error at UHC 2/10/09 JCH
$Joe = (substr($claim->insuredRelationship(), 0, 2)); // Need to eliminate code after SBR when Pt is not the Insured 2/10/09 JCH
if ($Joe != “18”) {
$PatientHL = “1”;
if (substr($claim->x12gsreceiverid(), 0, 10) == “9080111864”) {
$Joe = “”;
}
}
and then near line 231 replace $claim->insuredRelationship() with $Joe - fixes the problems for UHC, can be used for any other X12 receiver codes as well. Note that this will leave the correct value for $PatientHL of ‘0’ and ‘18’ after SBR when the insured is the patient, but ‘1’ (which means there are added elements as would be needed for a child) yet removes the ‘19’ which would otherwise be put after SBR. Why that odd action is required by HIPAA is anybody’s guess. Mine is that somebody at UHC got confused, but I do not have a lot of X12 submittals to go on. I simply know this fixed the problems. One other thing to note: OpenEMR pastes the date you enter insurance data into the “Effective Date”. But if you have claims which pre-date then, they will not be handled correctly for billing. You will not even be given a chance to fix it with a drop-down of all the Insurers (which would be a better way to handle it). You will be locked with “Unassigned”, which will cause other rejections even if you paste in the X12 Partner. So my advice is to make certain that “Effective Date” is earlier than ANY claims for a patient with that insurer.