X12 file missing some data in ISA envelope at top (header) (icd 10, 5010)

leongruenbaum wrote on Wednesday, March 02, 2016:

a ‘good’ x12 file looks like this:

ISA00 00 ZZPOST N TRACK ZZ042064683 1602291837*^005010242794570P*:~GS

whereas the problematic one is this:

ISA****** ** 0309111630U00401000000001602242253U00401024272513**:

i see it’s because values are missing. we had some problems related to which provider was involved, but the above were from same provider. i can’t see what is different about the two visits (different patients). any ideas where to look , please let me know

***that’s weird - just noticed that this form is deleting some of my asterisks in the bad one, so here is an image attached of the bad one

teryhill wrote on Wednesday, March 02, 2016:

is it the same insurance company and x12 partner?

Terry

leongruenbaum wrote on Wednesday, March 02, 2016:

yes - that’s what is so puzzling. in this case ‘postntrack’ and GHI

leongruenbaum wrote on Wednesday, March 02, 2016:

well the main question is what causes the missing data in the ‘bad’ one

teryhill wrote on Wednesday, March 02, 2016:

what version of OpenEMR are you on.

leongruenbaum wrote on Wednesday, March 02, 2016:

says 4.2.0(4)

teryhill wrote on Wednesday, March 02, 2016:

You can make this change. I have used it in other places to make sure the 5010 stuff is being set. This is about line 21 of \openemr\library\gen_x12_837.inc.php

//$CMS_5010 = strpos($claim->x12gsversionstring(), ‘5010’) !== false;
$CMS_5010 = true;

Terry

leongruenbaum wrote on Thursday, March 03, 2016:

oh ok - i’ll give it a shot. thanks so much for your your speedy response

leongruenbaum wrote on Thursday, March 03, 2016:

hmm - am i correct that this is code that is executed when i press “generate x12”? because i made your fix, re-opened the claim and just did ‘generate x12’ and it seems to be the same problem. (missing data in that first line). there is no need to re-enter the claim, right?

and i mean i assume there’s no need to re-boot or anything like that for the new code to be seen, right?

thanks

fsgl wrote on Thursday, March 03, 2016:

This is the explanation of the Inbound Transaction Header. The 6th pair field is 00501 (version 5010), not 00401.

If the X12 Partner dialog had been set up correctly & assuming data in attachment are correct (if not, check with your X12 Partner), this is how the header should look:

ISA*00* *00* *ZZ*postntrack *ZZ*042064683
*160229*1837*^00501*024279457*0*P:~

An asterick before & after text will italicize it. Use the Italic function (the slanted I, just to the right of the bold B) in the toolbar above to demonstrate.

For preformatted text (without markdown), use backquotes (`) before & after segment.

See Formatting Help for more details. The link is also available in the left sidebar as the last item.

leongruenbaum wrote on Thursday, March 03, 2016:

yes - and that matches my ‘good’ one above (tho this form is removing some asterisks)

so i guess u r saying somehow this particular claim is getting sent as 4010 i guess. at one point, post’n’track did tell us they thought we were sending 4010 as well. but i thought it was their misdiagnosis because i assumed that those fields ought to be populated even with it being 4010(?)

well, i think we will continue to submit more GHI’s to better detect a pattern of which visits come out ok and which don’t. i mean since it’s the same settings for x12 and the same provider, it’s mysterious one visit comes out this way and another doesn’t. maybe w more data i’ll be able to see a pattern of some kind.

if you have any thoughts on what could be different about these particular patients/visits let me know. thanks

leongruenbaum wrote on Thursday, March 03, 2016:

actually i saw the x12.png only now - i have exactly one x12 partner: post’n’track. should i do another one for GHI? i send those to post’n’track also. anyway i didn’t have the lower sender and receiver filled in as u do so i did those for my post’n’track entry. will see if that helps

leongruenbaum wrote on Thursday, March 03, 2016:

ok that didn’t change anything

fsgl wrote on Thursday, March 03, 2016:

You need to review these Users Guide sections about setting up insurance companies (GHI) & X12 Partner/clearinghouse (Post-n-Track).

When you first setup with Post-n-Track, their support should have supplied you with the Sender & Receiver numbers & helped you with the X12 Partner dialog box.

You cannot use the 4010 format for the electronic claim because it has been superceded by the 5010 format. If you choose 4010 in the X12 Partners dialog, it will mean an automatic rejection

The above X12.png is incorrect because info from your prior post was incorrect. See corrected attachment.

fsgl wrote on Thursday, March 03, 2016:

Found this enrollment webpage. At Step 10, Support should have contacted you to help you with setup.

Very strange that a search for a generic 837P Companion Guide yields only info for specific insurers.

See FAQ #15.

Webpage about using Office Ally.

leongruenbaum wrote on Thursday, March 03, 2016:

Thanks, FSGL

will check links- But judt to be clear , We did set up the x12 Partner form correctly because weve been using it for months w no problem. We did recently switch to 5010 w the new version of openemr, I guess, and again there havent been problems

i dont understand w the setting set to 5010 as it is currently, why this particular visit seems to be sending as 4010 and w gaps in the data

As i say, the only problem we seem to have is w this one ghi visit, possibly w that patient in general

am i correct that if we are sending these forms only to postntrack , then we need only one x12 partner, “postntrack”?

any clues why a particular patient/visit would cause a problem?

thanks - if u feel that the information u have sent answers these questioks above then i will check out before bothering u further, thanks

fsgl wrote on Thursday, March 03, 2016:

Hi Leon,

It’s never a bother, if we can be of help.

I think we need to work backwards a bit.

How was the X12 Partners dialog configured originally when Post-n-Track support helped you with the initial setup?

How does the Doodad Utility Tool work? (Sounds like a Southern dialect.)

Did support configured one X12 Partner for all your insurers? Or did they configure a separate X12 for each insurer, e.g.; one for GHI, one for Aetna, one for Unitedhealthcare, etc.?

The way it’s done at Office Ally is that only one X12 is configured for the clearinghouse, Office Ally. All our insurance companies will use that one X12 Partner, Office Ally. This makes things simple, like one-stop shopping.

If you have a separate X12 Partner configured for each insurer, this may be the source of the problem. There could have been a wrong selection in the Insurance part of the Patient Summary (Demographics) for this particular patient. An incorrect X12 Partner may have been designated for GHI in Practice/Insurance Companies or in the Billing Manager just before you clicked the Generate X12 button.

We should look at the screenshots for this patient. Black out the name, DOB, any other PHI for the patient & credentials for attending physician (NPI, Employer Tax ID) or use fictitious data before attaching screenshots.

Needed screenshots:

  1. Insurance section of Patient Summary.
  2. X12 Partner dialog box for GHI used for this patient.
  3. The pending claim of this patient in Billing Manager with the choices of the X12 Partner drop-down menu depicted.

Another option is to have you replicate the scenario in one of the Demo’s so troubleshooting would be more accessible.

We usually are able to diagnose the problem if we have enough information & if we go through the differential diagnoses methodically.

tmccormi wrote on Friday, March 04, 2016:

I guarantee you that in that version of openEMR that there is a bug that sometimes causes claims to be 4010 regardless of any setting. The only fix it to hard code 5010 format in the gen_x12 as Terry pointed out.

teryhill wrote on Friday, March 04, 2016:

Working on a version with no 5010 Right Art.

Terry

leongruenbaum wrote on Thursday, March 10, 2016:

thanks, fsgl.

thanks a lot. i apologize for the delay. this is a client i see only weekly and i wasn’t back here til now

just a note to remind u i did the hard coded 5010 fix and it didn’t change anything

How was the X12 Partners dialog configured originally when Post-n-Track support helped you with the initial setup?

i wasn’t here for the original set up but i imagine we were on phone with them and got the information. see attached.

How does the Doodad Utility Tool work? (Sounds like a Southern dialect.)

doodad takes the x12 files generated by openemr and sends them to postntrack. they assign some sort of case # and let us know within minutes if they have been accepted (at least initially, i.e. if they have a technical fault)

Did support configured one X12 Partner for all your insurers? Or did they configure a separate X12 for each insurer, e.g.; one for GHI, one for Aetna, one for Unitedhealthcare, etc.?

we have only postntrack as our x12 partner. sounds like that is the correct way to do it, yes?

The way it’s done at Office Ally is that only one X12 is configured for the clearinghouse, Office Ally. All our insurance companies will use that one X12 Partner, Office Ally. This makes things simple, like one-stop shopping.

If you have a separate X12 Partner configured for each insurer, this may be the source of the problem. There could have been a wrong selection in the Insurance part of the Patient Summary (Demographics) for this particular patient. An incorrect X12 Partner may have been designated for GHI in Practice/Insurance Companies or in the Billing Manager just before you clicked the Generate X12 button.

We should look at the screenshots for this patient. Black out the name, DOB, any other PHI for the patient & credentials for attending physician (NPI, Employer Tax ID) or use fictitious data before attaching screenshots.

Needed screenshots:
1.Insurance section of Patient Summary.
2.X12 Partner dialog box for GHI used for this patient.
3.The pending claim of this patient in Billing Manager with the choices of the X12 Partner drop-down menu depicted.

ok see attached - i also included the full x12 file that is generated for this person, with the missing data. i have made the info generic as u can see.

btw we recently made some adjustments which seemed to let us include GHI and Empire Plan, which previously weren’t working. (At this moment i am forgetting exactly what we did.) Some of those now do work; however, both of those providers - and this example is one of them (GHI) - have generated this type of file w blanks in it. We have never had this type of missing data with the other providers: Cigna, Aetna, United Health Care, Oxford. those all work consistently (btw, postntrack does not accept blue cross blue shield)

anyway i have attached everything u asked for - 3 jpgs and a text file. wasn’t quite clear which screen u wanted regarding billing. what i am attaching doesn’t show anything about x12. anyway, there is only one x12 partner in the system: postntrack

Another option is to have you replicate the scenario in one of the Demo’s so troubleshooting would be more accessible.

We usually are able to diagnose the problem if we have enough information & if we go through the differential diagnoses methodically.