We submitted 100+ claims to BCBSTX through Availity using X12 batch files created by OpenEMR. We just learned that all those claims are being paid directly to the patients instead of the provider.
We were told that on their end, “Accept Assignment of Benefits” was set to “N” which caused the problem. In OpenEMR, “Accept Assignment” is “YES” which is reflected in the outgoing X12 file as “A”. However, the next field in the X12 file is set to “N” which is what BCBSTX is probably using to make the determination as to who gets the check.
Examining the X12 file we see:
CLM07: Provider Accept Assignment Code <<< OpenEMR correctly sets this to “A”
CLM08: Yes/No Condition or Response Code <<< OpenEMR sets this to “N” resulting in patients getting the check
Is this a bug?
Shouldn’t OpenEMR set the second field to “Y”?
If not, where in OpenEMR do we set this?
We are using OpenEMR Version Number: v5.0.1 (7)