X12 Claim checks being sent to patients instead of provider

[DONMNELL]

Hello,

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)

Thank you.

Don

[stephenwaite]

hi @DONMNELL , since most facilities/practices would like accept assignment to be on by default will set that going forward. Thank you for bringing this up.

[DONMNELL]

Hi Stephen. Thanks for responding. Does that mean checking the “Accepts Assignment” checkbox that you referenced marked as “A” in the screenshot below will set CLM08 to “Y” in the X12 file or does that only set the dropdown marked as “B” to “YES”.

I believe that for the claim to be processed correctly, CLM07 has to be “A” and CLM08 set to “Y” in the X12 file.

[stephenwaite]

hi @DONMNELL choose A

[DONMNELL]

Thanks Stephen. I will give it a try this weekend and check the X12 file. Thanks again.