X12 file help with California Medi-Caid


(Jim_W) #1

Situation
Hi, looks like I’m one of the lucky few where installation was relatively breezy.

My question has to do w the x12 file. I was wondering if anyone can help or point me to documentation. I uploaded a 10 claims test file to the California Medi-Caid website. Their help desk said I have many errors: - I sent multiple transaction sets, which HIPAA allows but Medi-Cal does not. They also said Medi-Cal is 98% hippa compliant. I thought the beauty of a 5010 file is that it’s all standardized?

Oh, I also used “MC051”, as the electronic address but they said to use “610442” which seems easy enough to fix. Should I still try, seems rather difficult? If someone already has a format for Medi-Cal, I’d be glad to purchase it.

Thanks, Jim

OpenEMR Version
v5.0.1 (4)

Browser:
Chrome

Operating System
I’m using:

Logs
Did you check the logs? Was there anything pertinent in them? Paste them here (surround with three backticks (```) for readability


(Daniel) #2

What errors were you receiving?


(Jim_W) #3

Medi-Cal said I’m sending multiple transaction sets, which hippa allows but they dont. It’s weird but said can’t send me documentation…


(Stephen Waite) #4

https://files.medi-cal.ca.gov/pubsdoco/hipaa/hipaa_5010_home.asp


(Jim_W) #5

Thanks a million Stephen. Can’t believe the Medi-Cal guys didnt link this.

Does anyone know, is there a resource with preformatted x12 generators, say for Nordian Medicare, generic PPOs and Medi-Cal? Or does everyone learn to modify…that seems hard to believe and a duplication of resourcs.

Any help would be greatly appreciated.


(Stephen Waite) #6

hi @Jim_W, try setting up the X12 partner with the values they recommend, send a test claim, and report back with any errors. Thank you.


(Jim_W) #7

Hi Stephen,

Bruce at Conduent/Medi-Cal has been helping & I’ve updated the x12 partner fields based on his email. I also changed “processing format” to Medi-caid in x12. Looks like openemr already has a different format for them. However I’m still sending multiple transaction sets & got this reply today:

" see you sent a file but it was to the production server so I cannot see the raw data.

It did generate an error report which showed some errors, you have a PER (person)

MCWEB LOGIN ID: CMCSUB31E VOL-SER-NO: 195024

        *   TRANSACTION SET Sequence: 1 TransactionSetID: 837 Transaction Set Control Number: 0001                             



            *   TYPE 1: REJECT                                                                                                  



            *   SEGMENT At position: 4 PER06 {Administrative Communications Contact Number }                                               



                    *   Error Code: 2 {Conditional required data element missing.}                                             



                    *   Data Content:                                                                                (empty)                                                                                        



                                                                                                                                



                                                                                                                               



            *   SEGMENT At position: 15 N301  {Address Information}                                                                



                    *   Error Code: 1 {Mandatory data element missing}                                                         



                    *   Data Content:                                                                    (empty

The following is a problem as Medi-Cal only allows one transaction set;

TRANSACTION SET Sequence: 2

  • SEGMENT At position: 4 PER06 {Administrative Communications Contact Number }

                    *   Error Code: 2 {Conditional required data element missing.}                                             
    
    
    
                    *   Data Content:                                                                                (empty)                                                                                        
    

TRANSACTION SET Sequence: 4

The same,

TRANSACTION SET Sequence: 5

The same,

TRANSACTION SET Sequence: 6

The same,

TRANSACTION SET Sequence: 7

The same,

TRANSACTION SET Sequence: 8

The same,

TRANSACTION SET Sequence: 9

The same,

TRANSACTION SET Sequence: 10

The same,

· * **********************

You can add the missing phone number but multiple transaction sets will not be accepted.

Sincerely,"

Thanks so much!


(Jim_W) #8

This was my batch file. Thanks


(Stephen Waite) #9

let’s just get a claim on file and then deal with multiple STs per ISA

Guessing that you’re missing an email address and a street address on the admin->facility set up


(Jim_W) #10

Ok, thanks, I’ll double check on that and more this weekend. Wish open emr generated a file with isa1…isa08…instead of just the astericks. Id def check line by line against the 5010 guide you sent. Thanks!


(Stephen Waite) #11

you can go to Fees->edihistory to see the files that you generated in the billing manager in a friendlier way and once you click process they move to the csvtables and can be searched


(Daniel) #12

**NOTE: I hope this is sample data because if not you are posting PHI.

One easy way to look for missing data is to open it with a text editor and replace the ‘~’ with a ‘~ \n’ (basically a new line).

image

Your NM1*IL segement fir patient PID2 (the patients name and address) is missing the street address and city, and state. If this is Medical, they are probably expecting an address in California. If you look at your raw data (I removed the name and Medi-cal ID with X’s)

The N3 section should have a street address and the N4 should have a city, state, Zip like the following
output

The PER*IC degment is missing some contact info here. I don’t know if this is required, but from the error message this seems to be the case:

image

but here is an edited example from a working X12 file


(Jim_W) #13

You’re right, I’m so sorry for posting that. I planned on deleting it right away but haven’t found a way. I also figured it’s undecipherable to regular joe schmoes.

I’d really like to hire someone at an hourly rate to get this done. I consider myself somewhat technical, but the setup is way too “hands on” for me. Any takers? Thanks so much.


(Stephen Waite) #14

hi @Jim_W , deleted your batch, these are pretty trivial errors, just fill out the facility details so the fields that @growlingflea pointed out are filled